lower cervical spine instability
Introduction
Introduction to lower cervical instability The lower cervical instability is a instability of the cervical vertebrae located below the 2~3 cervical vertebrae. This disease can be regarded as a process of cervical degeneration, which is common in clinical practice and its disease is quite different. The clinical manifestations of lower cervical instability are quite different, ranging from mild neck discomfort to root radiation pain and even paralysis. This depends mainly on the degree of instability of the cervical spine, the difference in the size of the sagittal diameter of the spinal canal, the height of the affected vertebrae, the sagittal diameter of the dural sac and the speed of onset. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: paraplegia
Cause
Causes of lower cervical instability
(1) Causes of the disease
The cause of the disease is not similar to that of the upper cervical instability. The incidence of upper cervical instability is congenital, while in the lower cervical vertebra, acquired factors play a more important role.
(two) pathogenesis
1. Degenerative changes begin after the growth and development of the body ceases, meaning that each organization will develop in the direction of promoting its own form and function degradation, although this process continues until life stops, but is caused at different stages. The pathological anatomical features and consequences are not consistent. From the perspective of cervical instability, the main features are as follows:
(1) Early degeneration of the vertebral ganglia is mildly unstable: refers to the early stage in which the annulus fibrosus and nucleus pulposus have just begun to dehydrate, the volume becomes smaller and the elasticity is reduced. In this case, the vertebral ganglia is inevitably loose, and the lateral motility On the X-ray film, mild trapezoidal changes can be found in the cervical vertebrae. This pathophysiological change can easily irritate the sinus nerves in the posterior longitudinal ligament and root canal, causing local symptoms. The symptoms caused by this period are equivalent to cervical cervical vertebrae. Cervical spondylosis of the disease or cervical disc herniation; similarly, this period is also the pathological anatomy and pathophysiology of this type of cervical spondylosis.
(2) Degenerative mid-term vertebral joints are obviously unstable: the degeneration of the interbody joints is further aggravated, the nucleus pulposus is obviously dehydrated, and the rupture of the annulus fibrosus and the displacement of the nucleus pulposus, as well as the formation of the subperiosteal space of the ligament, In this case, it can cause obvious loosening and dislocation of the vertebral segments. In severe cases, there may even be a subluxation-like change. In this case, depending on the sagittal diameter of the primary or secondary spinal canal, there is a clinical manifestation. difference.
1 large spinal canal: refers to the sagittal diameter of the spinal canal in the normal range, most of the patients showed cervical symptoms caused by stimulation of the sinus nerve, and few clinical manifestations of spinal cord or nerve root stimulation.
2 small spinal canal: the smaller the spinal canal, the spinal cord, nerve root or vertebral artery caused by the displacement of the vertebral joint is more obvious. Therefore, it not only has the symptoms of cervical cervical spondylosis, but also may have root type, vertebra The main complaints and signs of arterial or spinal cervical spondylosis are characterized by a large change in symptoms and a close relationship with the position of the patient's neck.
(3) Recovery after vertebral instability in the late degeneration: due to the obvious instability in the early stage, subperiosteal hemorrhage around the intervertebral space, mechanization, cartilage, calcium deposition and ossification, so that the unstable vertebral segments gradually recover The original stability, although the anterior longitudinal ligament, the posterior longitudinal ligament and other surrounding ligaments are replaced by hyperplastic epiphyses, and can form continuous compression on the spinal nerve roots, vertebral artery or spinal nerves, but the stability of the vertebral segments is obtained. Recovery, the body's natural defense mechanism is harmful to the small spinal canal, but it is very beneficial to the large spinal canal, because the latter generally does not cause compression symptoms of the nerve tissue.
2. Trauma and strain In modern life, the chance of trauma is increasing. Especially the appearance of highways and high-speed vehicles increases the chance of spinal injury. Sudden trauma to the head and neck and chronic strain of the neck can cause Looseness and instability of different degrees of vertebral joints, especially when the external force causes vertebral insufficiency, the ligament of the vertebral ganglion is prone to tearing, and can directly cause similar consequences to the early or middle stage of cervical degeneration, especially the vertebrae. Sectional shift is obvious and the spinal canal is narrow.
3. The inflammation of the throat is mainly the inflammatory reaction of the throat and the upper respiratory tract. It is easy to recruit the ligaments around the vertebrae and the relaxation of the joint capsules, which will increase the involvement of the paravertebral muscles and lead to muscle weakness, which can further aggravate the cervical vertebrae. Unstable.
4. Other congenital malformations including cervical vertebrae, excessive weight and continuous traction during treatment, inappropriate manipulation, inappropriate neck exercise, and other injuries that can cause neck muscle atrophy can cause or Increase the instability of the cervical spine.
Prevention
Prevention of lower cervical instability
1. If you need to work in front of the computer for a long time, I suggest you buy a neckband for long-term cervical traction, which has obvious preventive effect on dislocation caused by small joint disorder. There are many kinds of neckbands now, airbag type. Too much skin, summer can use single steel or elastic plastic neck retractor, can continuously correct the bad posture of your neck, can keep the cervical spine in a healthy and correct position. Inside the neck hoop can be a layer of sachets, you can use Chuanxiong, Angelica, Ai Ye, wind, Qin Jiu, Eucommia, Salvia, Clematis, safflower in a cloth bag, use steam to slightly heat before wearing it will be more Ok, it can be taken for a long time.
2, early use of Shujinhuoxue drugs for improving the blood supply of neck muscle soft tissue, strengthen the recovery of neck muscle ligament function has a very good effect, can be applied with traditional black plaster, usually hot compress also has obvious effect, mainly to protect the neck Muscle soft tissue, to avoid strain caused by fatigue and other factors, if you can carry out physical therapy, hot compress, cupping and other treatments, the effect will be more obvious.
3, pay attention to the usual maintenance. You can exercise on your own every day: neck flexion, extension, right side, left side, left-handed, right-handed action 20 times each. The power is from light to heavy. At the same time, it is necessary to strengthen the strength of the neck muscles, and the strength of the neck is strong, so that the development of cervical instability can be well controlled.
Complication
Lower cervical instability Complications
If the spinal cord is severely compressed, it may be complicated by paraplegia.
Symptom
Symptoms of lower cervical instability. Common symptoms: stiff neck, stiff neck, ligament, sprain, joint capsule, ligament rupture
The clinical manifestations of lower cervical instability are quite different, ranging from mild neck discomfort to root radiation pain, and even paralysis. This depends mainly on the degree of cervical instability, the difference in the size of the sagittal diameter of the spinal canal, and the affected vertebrae. The height, the sagittal diameter of the dural sac and the speed of onset, etc., have obvious differences in clinical features and imaging findings. Therefore, typical cervical instability is shown on X-ray films, which can be clinically asymptomatic. However, if the spinal canal is obviously narrow or the dural sac is more developed, even a little looseness can cause serious symptoms, and even the central or the anterior central artery of the spinal cord is compressed (or stimulated), showing neurological symptoms. In one case, the clinical and imaging features of such patients must be considered comprehensively, and the symptoms that are more common in the clinic are now described.
1. The neck symptoms are mainly the irritation of the cervical sinus nerve, which is more common in neck discomfort, stiffness, inconvenience and pain. About 80% of patients feel uncomfortable in the head and neck. .
2. Root symptoms When unstable vertebrae cause root canal stenosis when the vertebral segments are displaced, the spinal nerve roots are stimulated or oppressed to cause different root symptoms.
3. The symptoms of vertebral artery insufficiency are mainly the second vertebral artery located in the transverse process hole, which is caused by stimulation or compression when the joint of the vertebral joint is displaced due to the displacement of the joint between the vertebral bodies.
4. Spinal cord symptoms are mainly caused by vertebral body edge stimulation or compression of the anterior spinal cord or anterior spinal cord central artery (or its branching sulcus artery). This group of symptoms is rare, but the consequences are serious and should be noted.
Examine
Examination of lower cervical instability
1. X-ray plain film in addition to the conventional cervical vertebrae, lateral position and oblique position, mainly shooting over-extension and over-flexion dynamic lateral slices, can clearly show the direction and extent of vertebral displacement, and should Measured, this change first appeared and was significantly earlier than seen in MRI images.
2. MRI examination for patients with spinal cord symptoms, should strive for MRI at the same time to determine the presence or absence of spinal cord and its extent, because the current magnetic resonance technique can not clearly show the dehydration changes in the vertebra, only when the vertebral section The development of the lesion to a certain extent can be shown, therefore, MRI examination can not be used as a basis for early diagnosis.
3. Other patients with obvious vertebral artery symptoms, especially before the formal treatment should be treated with vertebral artery magnetic resonance (MRA) or DSA examination, generally do not need CT and myelography.
Diagnosis
Diagnosis and diagnosis of lower cervical instability
From the perspective of pathological anatomy and pathophysiology, except for the ligament and joint capsule damage caused by the injury, the cervical spine instability is mainly a stage in the process of cervical disc degeneration, so it is different from lumbar instability. At present, few researchers regard it as an independent disease for diagnosis, but from the perspective of future development, once the different states of cervical spondylosis are classified as different diagnostic names, cervical instability is certainly one of its diagnostic terms. .
Diagnose based on
1. Except for history of medical history, the cervical spine is mainly in a state of over-flexion for a long time.
2. The clinical features are mainly neck symptoms. Depending on the affected tissue, there may be root or spinal symptoms, but it is rare.
3. Imaging findings are characterized by loosening and instability of the vertebral segments, especially on the lateral X-ray dynamics of the cervical spine. MRI examination is helpful for diagnosis and also contributes to cervical disc herniation (prolapse) and bone. The difference between proliferative cervical spondylosis.
Mainly different from cervical spinal canal stenosis, acute cervical nucleus nucleus (de-) and bone cervical spondylosis, after careful clinical and imaging examination, the general identification is no difficulty.
