cervical disc herniation
Introduction
Introduction to cervical disc herniation The onset of cervical spondylosis is mainly due to the degeneration of the cervical intervertebral disc, including the bulging, prominence and prolapse of the nucleus pulposus, which indicate different stages of cervical spondylosis, but often encounter sudden cervical disc herniation in the clinic ( Deviated from the disease, and most of them are the first symptoms of sputum. As early as 1978, the trapezoidal changes on the X-ray dynamic lateral radiograph and other clinical symptoms were determined, and the nucleus pulposus was removed by early surgery to obtain satisfactory results. Types of what we call "acute cervical disc herniation (de-)." In recent years, the development of MRI examination has confirmed this disease. basic knowledge The proportion of illness: 0.03% Susceptible people: no specific population Mode of infection: non-infectious Complications:
Cause
Causes of cervical disc herniation
High risk population
Cervical disc herniation is more common in young adults aged 20-40, accounting for about 80% of the patients. Occupation: People who maintain a fixed posture for a long time, such as office workers, computer operators, accountants, typists, teachers, drivers, bank staff, operating room nurses, traffic police, embroidery workers, long-term microscopes, painters, electricians, Engraving workers, car or mechanical repairmen, etc.
Gender: There are significantly more males than females in cervical disc herniation, more rural than in urban areas. Women often develop after pregnancy, often with sudden onset of severely low back pain and impediment to activities. People who work long hours or live in wet and cold environments are more likely to occur.
Predisposing factor
Age factor (10%):
With the increase of age, the wear of various parts of the human body is also increasing, and the cervical vertebrae will also produce various degenerative changes, and the degenerative changes of the intervertebral disc are the most important reasons for the development of cervical spondylosis.
Chronic strain (20%):
Refers to the damage caused by excessive activities beyond the normal range, such as poor sleep, improper height of the pillow or improper position of the pad, and the prevalence of repeated stiff neck is also higher. In addition, improper working posture, especially the long-term low-head workers, the incidence of cervical spondylosis is extremely high. In addition, some inappropriate physical exercise will also increase the incidence rate, such as illegal standing, tumbling and so on.
Trauma (15%):
On the basis of degeneration and instability of the cervical spine, the trauma of the head and neck is more likely to induce the occurrence and recurrence of cervical spondylosis.
Throat inflammation (10%):
When there is acute or chronic inflammation of the throat or neck, it is easy to induce symptoms of cervical spondylosis or worsen the condition due to inflammatory edema of the surrounding tissue.
Developmental spinal stenosis (18%):
Patients with spinal stenosis are more prone to cervical spondylosis and have a poorer prognosis.
Congenital malformations of the cervical spine (5%):
Various congenital malformations, such as congenital vertebral fusion, skull base depression, etc. are easy to induce cervical spondylosis.
Metabolic factors (6%):
Cervical spondylosis is prone to occur in people with metabolic disorders caused by various reasons, especially those with calcium, phosphorus metabolism and hormonal metabolism disorders.
Mental factors (7%):
From clinical practice, it is found that bad mood often makes cervical spondylosis worse. When cervical spondylosis is aggravated or attacked, the patient's mood is often worse, it is easy to be excited and lose temper, and the symptoms of cervical spondylosis are more serious.
Pathogenesis
Cervical hyperextension injury can cause the proximal vertebral body to shift backwards; flexion injury can dislocate or subluxate the bilateral facet joints, increase the tension behind the disc, cause the annulus to rupture, and the nucleus pulposus protrudes. Rizzolo reports that the cervical vertebrae After extensor injury, 60% of cases have disc herniation; after cervical flexion injury, 35% to 40% can have disc herniation. After cervical flexion injury, the incidence of disc herniation with the joint capsule rupture of the facet joint Increased and increased, 80% of cases with bilateral facet joint dislocation, disc herniation, in addition, Boyd believes that the intervertebral disc is the earliest in the human body, the most easily degenerative changes with age, with age The growth of the nucleus pulposus loses part of the water and its original elasticity, resulting in degeneration of the intervertebral disc. Cervical disc degeneration and rupture are related to local strain and systemic metabolism and secretion disorders frequently caused by cervical flexion and extension activities, due to the role of dentate ligament The cervical spinal cord is relatively fixed. When the external force causes the annulus fibrosus and the posterior longitudinal ligament to rupture, the nucleus pulposus protrudes, causing the cervical spinal cord to be compressed, and the fibers behind the cervical vertebrae The ring and the posterior longitudinal ligament are weak. The nerve root of the neck runs laterally into the intervertebral foramen at the level of the intervertebral disc. Even if there are few discs protruding, it can cause nerve root compression. It is generally believed that the mechanism of the disease is in the intervertebral disc. Suddenly, when there is no obvious degenerative change, the fibrous ring is ruptured due to a certain external force, causing the nucleus pulposus to protrude. The prominent nucleus pulposus directly causes compression of the cervical spinal cord or nerve root. Of course, in the vertebral ganglia In the case of degeneration, the disease is more likely to occur, and the disease is accompanied by cervical instability, which should be considered in judging the condition and diagnosis.
Prevention
Prevention of cervical disc herniation
Early detection and early diagnosis are the key to the prevention and treatment of this disease. In the usual work, especially those who maintain a fixed posture for a long time, such as office workers, computer operators, accountants, typists, etc., should pay attention to doing a small amount of activities at intervals. Reduce the incidence of the disease.
Complication
Cervical disc herniation complications Complications
Due to compression of the spinal cord, incomplete or complete paralysis of the limbs and abnormal bowel movements may occur.
Symptom
Symptoms of cervical disc herniation Common symptoms Cervical disc herniation Shoulder pain sensory disturbances Cervical vertebrae segmental abnormality Cervical demyelinating lesions Neck and shoulder fatigue and soft tissue pain Neck root trapezius and... Hand weakness and unconscious...
Cervical disc herniation causes compression of spinal nerve roots and spinal cord, causing headache, dizziness; palpitations, chest tightness; neck soreness, limited mobility; shoulder and back pain, upper limb numbness and other symptoms and signs, severe paraplegia is life-threatening.
According to the position of the cervical disc to the intraspinal protrusion, there are different clinical manifestations:
1 side protruding type:
Because the cervical spinal nerve root is stimulated or oppressed, it manifests as a unilateral root symptom. In the light, the numbness of the cervical spinal nerve innervation area (ie, the upper limb of the affected side) may occur. In severe cases, severe pain may occur in the affected area of the affected nerve segment, such as knife cutting or burning, accompanied by acupuncture or over-energy. Hemp, pain symptoms can be aggravated by cough. In addition, there are still painful torticollis, muscle spasm and restricted neck activity, and there may be symptoms such as upper limbs sinking, weakness, grip strength, and falling objects. Physical examination can find that the passive active neck or the pressure from the head to the vertical axis can cause pain, the affected nerve segments have changes in movement, sensation and reflex, and the innervation region has corresponding muscle weakness and muscle atrophy. Performance.
2 side central protruding type:
There are symptoms of unilateral nerve roots and unilateral spinal cord compression. In addition to the performance of lateral prominence, there may be different degrees of symptoms of unilateral spinal cord compression, which is characterized by increased muscle tension of the ipsilateral limb below the level of the lesion, weakened muscle strength, hyperreflexia, and shallow reflexes. Pathological reflex, tactile and deep sensory disturbances may occur; the contralateral side is mainly sensory disturbance, that is, temperature and pain disorder, and the distribution of sensory disturbance is not consistent with the lesion level, and the motor function of the contralateral lower limb is good.
3 central protruding type:
This type of symptoms without cervical spinal nerve involvement is manifested by bilateral spinal cord compression. Early symptoms are mainly sensory disturbances or dyskinesias. In the advanced stage, there are incomplete sputum sputum of different degrees of upper motor neurons or nerve bundle damage, such as awkward gait, inactivity, unstable walking, often Braids on the chest and waist, heavy ones can be bedridden, even breathing difficulties, incontinence. Examination showed increased muscle tension in the extremities, weakened muscles, hyperreflexia, shallow reflexes or disappearance, positive pathological reflexes, positive sputum and sputum.
Examine
Examination of cervical disc herniation
X-ray inspection
In each case, the cervical vertebrae, lateral and dynamic X-ray films should be routinely photographed. The cervical lordosis can be found to decrease or disappear during the reading. The affected intervertebral space is narrowed and may have degenerative changes in young cases. Or acute traumatic prominence, the intervertebral space can be found without abnormalities, but the affected segmental instability is seen on the lateral vertebral vertebral vertebral sinus, and the more obvious trapezoidal change (pseudo-subluxation) appears.
2. CT examination
CT examination is helpful for the diagnosis of this disease, but it is often not diagnosed on conventional CT films. In recent years, many scholars have advocated the use of myelography+CT (CTM) to diagnose cervical disc herniation, which is considered to be a diagnostic lateral prominence. The value is significantly greater than MRI; however, the authors believe that high-resolution, high-resolution magnetic resonance imaging techniques will be more beneficial to patients.
3. MRI examination
MRI examination is of great value in the diagnosis of cervical disc herniation, and its accuracy is significantly higher than CT examination and myelography. However, the judgment of cervical lateral protrusion is not as accurate as lumbar vertebra by MRI. This may be related to cervical intervertebral foramen. Small, lack of epidural fat and degenerative changes, on the MRI film can be directly observed that the intervertebral disc protrudes into the spinal canal, the disc herniation component and the residual nucleus pulpus signal intensity is basically the same, in the central type of prominent, visible disc Obviously compressing the cervical spinal cord, causing it to flatten or sag locally. The cervical spinal cord signal is abnormal in the compressed part. In the lateral type, the prominent intervertebral disc can be deformed by the lateral side of the cervical spinal cord, the signal intensity changes, and the nerve root disappears. Or shift backwards.
Diagnosis
Diagnosis and differentiation of cervical disc herniation
Diagnostic criteria
According to the medical history of the disease, clinical manifestations and imaging findings, there is no difficulty in the diagnosis of cervical disc herniation.
1. The classification of the disease is clinically. From the perspective of the incidence, the disease can be divided into the following three types:
(1) Acute cervical disc herniation: refers to acute onset, with corresponding complaints and clinical manifestations of spinal cord or spinal nerve root compression; imaging examination confirmed the presence of disc rupture or protrusion, and shows signs of compression of the cervical spinal cord or nerve roots, This type is the most common, clinical symptoms are also obvious, after timely diagnosis and early active treatment, more than 90% of cases can be cured.
(2) Traumatic cervical disc herniation: This type is more common in the clinic last time, and its characteristics mainly include the following three points:
1 History of trauma: In detail, each case has a history of head and neck trauma, especially the incidence of accidental trauma, including sudden braking on the highway.
2 Symptoms after injury: healthy people without any symptoms before injury, but the clinical manifestations of cervical spinal cord or nerve root compression immediately after injury, accompanied by local symptoms of cervical vertebrae.
3 imaging examination: suggesting that the intervertebral disc has obvious protrusion or prolapse, and oppress the cervical spinal cord or nerve root; this type has no cervical vertebrae fracture or dislocation, but about 50% of cases are associated with spinal stenosis.
(3) Chronic cervical disc herniation: refers to slow or subacute onset, most of them occur after many days of continuous fatigue, especially in the case of many days of burying the book (copy) is more common, in addition to the cervical vertebrae In addition to local symptoms, the main manifestations of the cervical spinal cord or cervical spinal nerve root compression signs, imaging examination confirmed that the pressure is a prominent intervertebral disc, there should be no bone compression.
2. Prominent site and symptom classification: From the point of view of diagnosis and treatment, it is more meaningful to classify according to the location of the nucleus pulposus (de-), which is generally divided into the following two types:
(1) Central type: refers to the nucleus pulposus protruding from the posterior center of the vertebral column to the spinal canal. The clinical symptoms are mainly the weakening of the limbs and the symptoms of sensory disturbance caused by spinal cord compression. MRI, CTM and other imaging examinations show the intervertebral disc. Prominent, and oppress the central or spinal cord, mostly accompanied by spinal stenosis.
(2) Lateral type: refers to the nucleus pulposus protruding to the side, which is divided into multiple types (3 or 4) by foreign scholars, but it is easy to be confused, difficult to distinguish, and more difficult to grasp. This type is root pain. The main clinical manifestations, MRI or CTM examination showed that the disc herniation was located in the anterior lateral aspect of the spinal canal, so that the cervical spinal nerve root was compressed; a few cases were accompanied by partial compression of the spinal cord.
Differential diagnosis
This disease should be distinguished from cervical spondylotic and radiculous cervical spondylosis and intraspinal tumors. In the current high-definition imaging techniques such as CTM and MRI, it is generally not difficult to distinguish. Therefore, this case should be routine. Perform an MRI check to prevent misdiagnosis.
