cervical spinal stenosis
Introduction
Introduction to cervical spinal stenosis Under normal conditions, the inner diameter of the cervical spinal canal (the anterior and posterior sagittal diameters and the lateral diameter) has a certain size to accommodate the spinal nerves and other tissues in the spinal canal. However, if the inner diameter is smaller than normal, especially when the absolute value of the sagittal diameter is less than 12 mm, the spinal canal is relatively narrow, and when it is less than 10 mm, it is absolutely narrow, and a series of symptoms can be caused thereby. The treatment of this disease is still based on non-surgical treatment, but patients with long-term treatment should still expand the sagittal diameter of the spinal canal. basic knowledge The proportion of illness: 0.076% Susceptible people: no specific population Mode of infection: non-infectious Complications:
Cause
Causes of cervical spinal stenosis
(1) Causes of the disease
The pathogenesis of sagittal stenosis of the spinal canal is multifaceted. In addition to the flattening of the spinal canal itself, it is related to factors such as hyperplasia of the lamina, short pedicle, hypertrophy of the small joint or growth in the direction of the spinal canal. Hypertrophy is also associated with innate development.
(two) pathogenesis
1. Congenital developmental factors: Innate developmental factors are mainly achondroplasia, which is more common in clinical practice and is the main cause of morbidity. The authors observed through thousands of surgical cases. Such factors have a certain relationship with families and regions. Some regions and families are more frequent, and will be continuously verified from genetic research in the future.
Due to the developmental stenosis of the spinal canal, the volume of the spinal canal is reduced, and the local effective gap is reduced, so that the spinal cord tissue in the spinal canal is in a critical saturation state. This patient has some secondary factors, including trauma, in the day after tomorrow. Sexual edema, unstable vertebral ganglia, prominent nucleus pulposus (or prolapse) and spur formation, are easy to irritate the spinal cord tissue in the spinal canal, causing neurological symptoms, the smaller the sagittal diameter of the patient, the heavier the disease; The larger the body, the more obvious the symptoms (Fig. 1, 2). On this basis, if the patient is accompanied by ossification of the posterior longitudinal ligament or other pathological anatomical factors, the patient is not only seriously ill, but also has difficulty in treatment and poor prognosis.
2. Acquired general additional factors: refers to the absence of obvious organic changes, mainly due to the loose and unstable vertebral joints caused by the intervertebral joints, the posterior small joints and the hook joints, the displacement is very small Although it can have no effect on a large spinal canal, in the case of spinal canal stenosis, the symptoms of stimulation or compression of the spinal cord or spinal nerve root can occur immediately.
In addition, the anterior ligamentum flavum may also be invaginated due to loosening of the vertebral ganglia, resulting in increased pressure in the spinal canal and constituting the evoked and dynamic factors of congenital spinal stenosis.
3. Acquired secondary factors: essentially organic lesions appear on the basis of the former, the pathological changes are mainly the formation of bone spurs, thickening of the ligamentum flavum, nucleus pulposus (prolapse) or nucleus pulposus + calcification, etc. The difference between the former is that such factors and developmental spinal stenosis together constitute a direct cause of its onset, and have a persistent characteristics; in general, non-surgical treatment is often difficult to eradicate.
Prevention
Cervical spinal stenosis prevention
1. Establish a correct attitude, master scientific methods to prevent and treat diseases, and cooperate with doctors to reduce recurrence.
2. Strengthen the exercise of the neck and shoulder muscles. When the work is idle, the flexion, extension and rotation of the head and the upper limbs can relieve fatigue, strengthen the muscles and strengthen the toughness, thus facilitating the neck section. The stability of the spine enhances the ability of the neck and shoulder to conform to sudden changes in the neck.
3, correct bad posture and habits, avoid high sleep, do not shrug shoulders, talk, read a book when you should look positive. Keep the integrity of the spine.
Complication
Cervical spinal stenosis complications Complications
In severe cases, it can be complicated by complete paralysis.
Symptom
Symptoms of cervical spinal stenosis Common symptoms Limb numbness dysfunction Urinary urinary frequency constipation Muscular atrophy Spinal cord compression Palmar reflex sensation Separation spur formation
Clinically, this disease is often confused with cervical spondylosis. In fact, the two are easy to coexist. Because the pathogenesis of cervical spondylosis is mostly based on the pathological anatomy of spinal stenosis; disc herniation, prolapse And the formation of osteophytes is also a predisposing factor for spinal stenosis. Therefore, for clinicians, the key is to distinguish between the first one and the other, which is crucial for the choice of treatment and prognosis. Observations, the authors found that developmental or primary cervical spinal stenosis generally has the following characteristics:
1. Sensory disorder: The vast majority, even more than 95% of cases have this group of symptoms, mainly manifested by numbness of the limbs, skin allergies or sensory separation, mainly due to the spinal thalamus bundle and other sensory nerve fiber bundles involved Towards, its characteristics are:
(1) Occurrence earlier: Most of the symptoms of this group of symptoms appear first in the early stage of the disease, which is significantly different from cervical spondylosis, especially cervical spondylotic myelopathy. The symptoms of the latter are late.
(2) Upper limbs: More than 90% of the cases begin with the upper limbs, especially in the arms, or from the shoulders.
(3) Mainly for hemp and pain: The patient complained that there were fingers (mostly at the fingertips) or pain and numbness in the arm when the disease was first developed, especially tingling.
(4) Symptoms persistence: When the sensory disorder occurs, it usually lasts for a long time, and may have paroxysmal aggravation. It is related to various predisposing factors, and remission period may occur after non-surgical treatment.
2. dyskinesia: more than a few weeks or months after the onset of symptoms of dysfunction, most of which are found during examination, mainly manifested as pyramidal tract sign, patients are mostly from gait, lower limbs, difficulty in lifting, easy Symptoms such as tripping and banding begin to occur, and the symptoms become more and more aggravated as the course of the disease progresses.
3. Muscle atrophy: The symptoms of muscle atrophy in patients with simple cervical spinal stenosis are generally later than those in patients with cervical spondylotic myelopathy. However, when combined with cervical spondylotic myelopathy, the symptoms of this group are not only early, but also Obviously, the scope is also wide, the reason is mainly due to the multi-segment of the developmental spinal stenosis, so once the various factors cause the spinal cord to be involved, often several segments appear at the same time, the plane at the time of examination Generally, it will not exceed the innervation area of the highest segment of spinal stenosis. This is obviously different from the level of muscle atrophy in the lateral sclerosis of the spinal cord to the level of the neck 2, and at the same time, it should be noted that the occipital neck deformity is excluded. Case.
4. Reflection disorder
(1) Deep reflex: more hyperthyroidism, including: biceps reflex of upper limbs, triceps reflex and periosteal reflex of the tibia; lower limbs are mainly knee reflex and tendon reflex, mostly symmetrical active or hyperthyroidism.
(2) Shallow reflex: It also appears to be weakened or disappeared. Clinically, it is mainly abdominal wall reflex, cremaster reflex and anal reflex.
(3) Pathological reflex: more positive, with Hoffmann sign, palmar reflex and Babinski sign positive.
5. Other performance
(1) dysfunction of the stool: more in the middle and late stages, frequent urination, urgency and constipation are more common; later can cause urinary retention, and even incontinence, but the latter is rare in the clinic.
(2) Autonomic symptoms: Most of the gastrointestinal and cardiovascular symptoms, accounting for about 30% of all cases (not easy to be detected and diagnosed before surgery, most of which were confirmed to be due to this after healing or significant improvement).
(3) Neck defense: These patients often maintain the neck in the natural position (function position), can be flexed, afraid of stretching, but if the patient is accompanied by significant degenerative changes, the scapula has a spur Forming, is also afraid of bending forward.
Examine
Cervical spinal stenosis examination
1. X-ray plain film examination: the conventional X-ray film, mainly on the lateral position, can clearly show the sagittal diameter of the cervical spine. When the standard sagittal diameter of 180cm is less than 12mm, it is It has diagnostic value; it has diagnostic reference significance when it is 12~14mm; it can be diagnosed completely under 10mm, and it can also be judged according to the ratio of sagittal diameter of vertebral body to spinal canal. It is abnormal if it is less than 1:0.75, less than 1: It has a diagnostic significance at 0.6, and the ratio can be completely diagnosed when the ratio is less than 1:0.5.
2. CT (or CTM) and MRI examination; can clearly show the size and shape of the sagittal diameter of the spinal canal and its relationship with spinal cord compression, CT examination mainly shows bone tissue, while MRI examination is clearer for soft tissue imaging Therefore, the combination of the two is the most ideal, which is not only conducive to diagnosis, but also conducive to the determination of the state of the spinal canal tissue to determine the treatment plan and the choice of surgical procedure.
Diagnosis
Diagnosis and diagnosis of cervical spinal canal stenosis
diagnosis
The diagnosis of this disease should be based on the clinical main point of view, can not be diagnosed only by the size of the sagittal diameter of the spinal canal, the author has encountered many cases of X-ray plain film showing normal sagittal diameter of the spinal canal, but has a typical cervical vertebrae In patients with stenosis symptoms, the dural sac is confirmed to be hypertrophic after surgery. The original symptoms disappear after posterior decompression. Care must be taken in the diagnosis of such patients. Those who lack clinical experience should not undergo random surgery to prevent misdiagnosis. Miscarriage has caused adverse consequences.
Differential diagnosis
1. Identification of cervical spinal stenosis and cervical spondylosis Although cervical spondylotic stenosis and cervical spondylosis are often associated with clinical, even more than 80% of cervical spondylosis is based on the pathological anatomy of spinal stenosis, but Single-shot patients can also be encountered, so the two should also be distinguished, especially for the development of developmental spinal stenosis and cervical spondylotic myelopathy, although both may be operated, but the surgical approach is one After that, the general direction is different. Even if the two are accompanied, it is necessary to decide the primary and secondary, in order to arrange treatment and implement the plan.
2. The identification of primary (developmental) cervical spinal canal stenosis and secondary cervical spinal canal stenosis is similar in the later stage, but because of its obvious pathogenic factors, it is completely different in diagnosis and treatment. Need to be identified.
3. Identification of cervical spinal stenosis and spinal sclerosis In recent years, the incidence of spinal sclerosis has increased, and most of the patients are younger and need to be identified.
4. Identification of other diseases In addition to the above three diseases, it is necessary to distinguish from ossification of the posterior longitudinal ligament, idiopathic, diffuse, hypertrophic spondylitis, intraspinal tumor, syringomyelia and peripheral neuritis. In addition to the clinical characteristics of the above various diseases, it should be identified based on imaging findings.
