neck and waist syndrome
Introduction
Introduction to cervical and lumbar syndrome The so-called neck and waist syndrome refers to the simultaneous stenosis of the cervical vertebrae and lumbar spine, and the occurrence of intraspinal nerve compression and clinical symptoms at the same time, the incidence of cervical spondylosis and cervical spinal stenosis patients About 20%. Cervical spinal canal stenosis and patients with cervical spondylotic myelopathy (mainly with spinal cord compression symptoms) showed developmental stenosis, and the ratio of vertebral body to sagittal diameter of the spinal canal was less than 1:0.75. The absolute value of the sagittal diameter is more than 12mm, and even cases with sagittal diameter less than 10mm, but less than 6mm are rare. basic knowledge The proportion of illness: 0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: thoracic disc herniation Cervical spinal stenosis Cervical disc herniation
Cause
Cause of neck and neck syndrome
Cervical and lumbar spinal stenosis (20%):
The disease is caused by stimulation or compression of the spinal canal tissue due to cervical and lumbar spinal stenosis. The cause of cervical and lumbar syndrome is based on the common pathological and anatomical features of the neck and lumbar vertebrae. Therefore, the mechanism of cervical and lumbar nerve damage is also consistent.
Pathogenesis
The cause of cervical and lumbar syndrome is based on the common pathological and anatomical features of the neck and lumbar vertebrae. Therefore, the mechanism of cervical and lumbar nerve damage is also consistent, which is caused by stimulation or compression of the spinal canal tissue due to spinal stenosis. There are a series of symptoms, except for the ligaments and dural sacs in the spinal canal, which mainly affect the sinus nerves, and the local symptoms of the vertebral nodes are reflected reflexively through the spinal nerve roots. Later, due to the cervical spinal cord and spinal nerve roots , or the horse's tail is compressed to cause limb symptoms and signs.
When the cervical vertebrae of the cervical vertebrae and the lumbar vertebrae are simultaneously stenotic, what exactly is the first disease? The authors have found through clinical observation for many years that most cases start from the cervical segment. The reason is mainly due to the fact that the cervical spinal cord is a substantial structure. There is no room for retreat, especially in the neck enlargement, which is relatively fixed by the dentate ligament and the spinal nerve root. Therefore, when there is some degenerative factor in the growth and development of the acquired day, such as the nucleus pulposus, the vertebral ganglia is loose, Hypertrophy of the ligamentum flavum, and even the loosening and displacement of the vertebral segments can induce the onset of the disease. The narrow lower lumbar spinal canal is susceptible to trauma, overburden, strenuous exercise and various degenerative factors. Further stenosis, especially the vertebral hyperplasia and spur formation may cause segmental stenosis, but because the cauda equina in the dural sac is mostly free, its activity is significantly larger than that of the cervical spinal cord, and because of its It is flexible, and the retention gap of the spinal canal is large. Therefore, it is only caused by various factors to cause further stenosis of the vertebral ganglia, including extensive hyperplasia of the vertebral ganglia and formation of the lip and lip. The spinal canal compensation gap disappears, and the pressure reaches the corresponding level, that is, the symptoms appear when the compensation interval is exceeded. On the other hand, the cervical spinal cord is located at a high place, and the symptoms produced after the compression are not only involved in a wide range. And more serious, so it is easy to show first, but when the neck lesions are diagnosed and treated, especially after the decompression of the bones, the symptoms of the upper extremities are relieved, and when the symptoms of the lower extremities still exist, The waist problem was suddenly revealed.
The pathogenesis of this disease varies according to the patient's own body position. When the body is at rest, the narrow spinal canal directly affects the spinal cord, cauda equina or nerve root, or passes through the sinus nerve. Reflexively causing symptoms, the degree is generally mild, in the dynamic state, the flexion can make the symptoms of the spinal canal and the volume can be relieved; but if the spine is stretched backward, the spinal canal The effective internal space becomes smaller (mainly due to the relaxation and invagination of the ligamentum flavum, wrinkles and other changes in the spinal cord and nerve roots), and it is easy to induce various symptoms. In severe cases, even general physiological activities such as walking, exercise, etc. Can be caused by spinal nerve root congestion, congestion and spinal microcirculation disturbances, including vascular circulatory disorders on the soft meninges, causing ischemic spinal radiculitis or ischemic soft meningitis, etc. A series of symptoms have appeared.
Prevention
Cervical and lumbar syndrome prevention
The problem of the neck and waist is always a problem with the spine. Most of the problems of the spine are caused by poor posture, so developing good habits can prevent cervical and lumbar diseases.
First of all, you should maintain a good posture when sitting, standing, walking, and lying. To "stay like a loose, sit like a clock", when standing, the torso should be straight and the shoulders and arms should be stretched. When sitting, the waist should be straight and the center of gravity should fall on the pelvis. People who sit in the office for a long time often change their position to prevent joint stiffness, ligament hardening, coagulation, strain and other degenerative diseases caused by long-term fixed posture. Good sleep is important for the health of the spine. An adult sleeps 6 to 9 hours a day, that is, 1/4 to 1/3 of the time is spent on sleep (pillows), so the pillow must be suitable for the physiological requirements of the neck to keep it asleep. Healthy posture. Sleep should be placed in the center of the pillow, mainly on the back, supplemented by the side, alternating left and right, the left and right knee joints are slightly opposite each other. Prone, semi-prone, semi- supine or upper and lower body torsion and sleep, are all bad sleeping posture, should be corrected in time.
Secondly, to maintain exercise, especially white-collar workers who often sit in the office, must take time to move the spine and promote blood circulation. Walking is also a good maintenance activity and can stretch and relax the spine. Swimming is also very good. In the water, the spine and the joints of the body are no longer subject to the pressure of the body's gravity. At the same time, the back muscles can be exercised to strengthen the protection of the spine.
Complication
Complications of cervical and lumbar syndrome Complications Thoracic disc herniation Cervical spinal stenosis Cervical disc herniation
Can be combined with disc herniation and spinal stenosis.
Symptom
Symptoms of neck and lumbar syndrome Common symptoms Neuralgia, radiation pain, disc herniation, sensory disturbance, forced position, lumbar disc herniation, spinal cord compression, lumbar spinal stenosis, backache, weakness
Because the pathological anatomy and pathophysiological changes of the disease involve two anatomical parts of the neck and lumbar segments, the pathogenesis of this disease is accompanied by symptoms of lumbar spinal stenosis accompanied by cervical spinal cord compression or irritation. Symptoms can be seen one after the other, but also coexist at the same time, but it is more common in the clinic that after the neck surgery, the symptoms of the lower extremities are not improved or not changed at all. After the examination, the lumbar spinal stenosis is found. Symptoms; may also be in the hospital because of the symptoms of the waist, the examination was found to be accompanied by cervical spinal cord compression symptoms; there are also many cases of cervical spine symptoms found after lumbar surgery, this situation is more common in primary care units .
The characteristics of the neck and waist symptoms are now described.
1. Characteristics of cervical symptoms
(1) Spinal cord compression or irritation: Because its pathological anatomy is spinal stenosis, its spinal cord symptoms are predisposed to sensory disturbances, and more common, accounting for more than 90%. After the mid-term, due to the severity of the lesions It can affect the symptoms of dyskinesia, and it becomes more and more obvious as the disease progresses, and it attracts the attention of patients. The root symptoms of these patients are mostly mild or absent.
(2) Imaging findings: In the X-ray, CT and MRI examinations, the spinal canal showed signs of developmental stenosis. The ratio of the sagittal diameter of the spinal canal to the sagittal diameter of the vertebral body was mostly less than 0.75, and the absolute value was less than 12 mm. Many of them can be under 10mm. MRI examination can clearly show the condition and specific parts of the dural capsule.
(3) Non-surgical treatment is effective, but the symptoms of lower limbs are not changed: the symptoms caused by this disease are caused by neck and lumbar lesions. The effective dry head and neck and light weight can relieve the symptoms of upper limbs and trunk, but It is difficult to improve the symptoms of both lower extremities. Therefore, those who encounter this condition, including those after neck decompression, should be further examined for the waist.
2. Characteristics of lumbar symptoms
The main symptoms of the lumbar symptoms are the following three characteristics. When the three are coexisting, it is not only of diagnostic significance, but also important for differential diagnosis. It should be fully understood and confirmed.
(1) Intermittent claudication: that is, when the patient walks tens of meters or hundreds of meters, there is one side or two sides, or one side is the weight of the waist and leg symptoms, which is characterized by backache, leg pain and numbness of the lower limbs. Even when you take a break or sit down for a few minutes, you can continue walking. In this way, you can walk continuously. Because of the intermittent period, the name is intermittent, which is mainly due to the lower limbs during walking. Muscle relaxation causes physiological congestion of the nerve roots in the corresponding spinal segments of the spinal canal. This has no effect on normal people and does not cause any symptoms; however, in the case of spinal and root canal stenosis, due to its Obstruction of the pathway will inevitably affect the return of local blood, and gradually form venous congestion, resulting in ischemic radiculitis due to microcirculatory disorders, and a series of symptoms appear as the nerve roots are pulled while walking, but when a little After sitting down or sitting, after rest, the symptoms of the lower limbs muscle activity during walking are eliminated, and the spinal canal is restored to the normal width, and the symptoms are alleviated or disappeared.
(2) Contradiction between chief complaint and objective examination: This is another characteristic of this disease. Because the spinal canal stenosis makes the volume of cauda equina and nerve root in the spinal canal at the lowest point of the normal range, when the patient walks or is in long distance There are many complaints about the increased position of the spinal canal, and there may be typical sciatic nerve radiation pain, especially in the early and middle stages of the disease, but at the time of the visit, due to the short break before the clinic, The intraspinal pressure is restored to the original state, so the examination is often negative. The inconsistency between the main complaint and the physical examination may easily cause the patient to be mistaken as "exaggerated complaint" or "scam", but in the later stage of the disease, or Is due to various additional factors, such as combined disc herniation or prolapse, as well as lower lumbar instability, bone hyperplasia and intraspinal adhesions, and constitute a continuous space-occupying lesion in the spinal canal, there may be positive signs, It has the characteristic of increased symptoms and motility.
(3) Restriction of the lumbar extension and pain: Because the disease has developmental spinal stenosis, the effective gap of the spinal canal is reduced or disappeared. Therefore, when the lumbar vertebrae are from the neutral position to the posterior extension position, The small joint capsule and the ligamentum flavum behind the spinal canal are squeezed outside the spinal canal and nerve root canal. The length of the spinal canal is also shortened by 2.2 mm (according to the general body), the intervertebral foramen is narrowed, the intervertebral disc is directed to the spinal canal, and the spinal cord and nerve root are The cross-section is thickened, so that the intraluminal pressure is increased sharply, the patient's lumbar extension is limited, and various symptoms appear, but when the waist is restored to the straight position or slightly forward, the spinal canal is also restored. By the original width, the symptoms are immediately eliminated or relieved, so these patients can not ride, but can ride a bicycle (the clinical case is called a position type), but if the lumbar disc herniation is combined, the waist can not Continue to bend forward, even when slightly flexed, there are symptoms of low back pain and sciatica.
The above three symptoms can occur in almost every patient, and the positive rate is very high. The positive rate is as high as 98%. Therefore, this can be used as the basis for clinical diagnosis. In fact, only some cases require further imaging examination. To confirm the disease.
In addition, due to the length of the disease, the degree of disease, etc., the patient may be accompanied by other symptoms. Because the spinal canal of the patient has a stenosis, the slight protrusion (or prolapse) of the nucleus pulposus can stimulate or compress the spinal nerve root. Symptoms of root radiation pain and limited lumbar flexion during disc herniation. Therefore, most of these patients are diagnosed with lumbar disc herniation (or prolapse). The disease is only found after hospital treatment. Elderly patients can still Clinical symptoms associated with hypertrophic spondylitis, facet joint hyperplasia and vertebral body callus formation should be thoroughly examined.
Examine
Examination of neck and neck syndrome
1. The clinical manifestations of cervical spinal canal stenosis, mainly manifested as local and systemic symptoms and signs caused by cervical spinal cord compression or stimulation.
2. The clinical manifestations of lumbar spinal stenosis, mainly manifested in the characteristics of the three major clinical symptoms and their corresponding changes, early positive functional signs in the late stage.
3. Imaging findings: X-ray or CT, CTM examination showed that the ratio or absolute value of the sagittal diameter of the cervical and lumbar spine to the vertebral body was smaller than the normal value.
Others: In addition to conventional neck and waist X-ray and CT, CTM examination, MRI can also be used if necessary. Myelography has been used as the main basis for the determination of spinal stenosis, but this invasive examination has a large side effect and has been replaced by MRI and CT.
Diagnosis
Diagnosis and diagnosis of cervical and lumbar syndrome
Diagnostic criteria
According to the aforementioned clinical features, the disease is not difficult to diagnose, mainly based on the following characteristics:
1. Clinical manifestations of cervical spinal stenosis
Mainly manifested as local and systemic symptoms and signs caused by compression or stimulation of the cervical spinal cord.
2. Clinical manifestations of lumbar spinal stenosis
The main manifestations are the characteristics of the three major clinical symptoms and their corresponding changes, with functional changes in the early stage and positive signs in the later stage.
3. Imaging findings
Whether X-ray or CT, CTM examination showed that the ratio or absolute value of the sagittal diameter of the cervical and lumbar spine to the vertebral body was smaller than the normal value.
4. Irritability
Because the cervical spine and the lumbar spine have developmental stenosis, some space-occupying lesions appear in the area adjacent to the spinal canal, such as the loosening and displacement of the vertebral ganglion, bulging, protruding or prolapse of the nucleus pulposus, and the ligamentum flavum Relaxation or hypertrophy, as well as generalized pathological factors such as loosening of the facet joints, hyperplasia and mutation, can induce various spinal cord or root symptoms (previously more).
5. Other
In addition to conventional neck and lumbar X-ray and CT, CTM examination, MRI can also be used if necessary. Myelography is used as the main basis for determining spinal stenosis, but this invasive examination has a large side effect. Replaced by MRI and CT examinations.
Differential diagnosis
The disease is mainly caused by stimulation or compression of the spinal cord or cauda equina of the cervical and lumbar spinal canal, mainly due to cervical spondylosis, lumbar disc herniation and involvement of the pyramidal tract. Identification of these diseases:
Lateral sclerosis
More common, neck and lumbar syndrome is caused by the weakening of the upper and lower limbs, or it is easy to be confused with the disease. However, the whole process of the disease is not accompanied by sensory disturbance. The patient's age of onset is light, muscle strength is weakened and muscles are weak. The atrophy is more obvious, the cervical vertebrae and the lumbar vertebrae have no stenosis, and there are no three clinical symptoms unique to lumbar spinal stenosis. As long as they are carefully examined, they are generally easy to identify.
2. Syringomyelia
Because of the feeling of more symptoms, it is also easy to be confused with cervical and lumbar syndrome, but most patients with syringomyelia are associated with sensory separation and nutritional disorders. There are no three clinical symptoms of lumbar spinal stenosis, which are easy to distinguish. MRI is helpful for identification. .
3. Peripheral neuritis
Most of them are caused by various causes of poisoning and peripheral nerve inflammatory changes caused by various infections. The main manifestations are bilateral symmetry, motor and autonomic dysfunction, and no spinal cord compression and three major symptoms of the waist. It is generally easy to identify.
4. Secondary adhesion arachnoiditis
In addition to various factors, including iatrogenic factors, long-term spinal stenosis is also easy to secondary to this disease. The former can be identified according to the primary injury, the latter is more difficult to distinguish, especially Later cases are often judged by imaging examinations such as MRS (spinal magnetic resonance) or myelography. For cases requiring surgery, it can be confirmed by intraoperative dural sac puncture.
5. Spinal cord hernia
It is caused by late syphilis and is mainly caused by sensory disturbance. It is rare at present. The patients have the characteristics of smelting history, blood Kanghua positive and Xia's joints, which are generally easy to identify.
6. Other
Including multiple sclerosis, extensive neck and lumbosacral fasciitis, osteoporosis and degenerative spondylitis, etc., should be noted.
