Esophageal compression type cervical spondylosis
Introduction
Introduction to esophageal compression cervical spondylosis Esophageal compression type cervical spondylosis, also known as dysphagia type cervical spondylosis, is relatively rare in clinical practice. Because it is rare, it is easily misdiagnosed or missed, so it should be noted. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: peptic ulcer
Cause
Esophageal compression type cervical spondylosis
(1) Causes of the disease
Mainly due to intervertebral disc degeneration secondary anterior longitudinal ligament and subperiosteal tear, hemorrhage, mechanization, calcification and bone spur formation.
(two) pathogenesis
Mainly due to intervertebral disc degeneration secondary anterior longitudinal ligament and subperiosteal tear, hemorrhage, mechanization, calcification and bone spur formation, the size of this spur is different, in the middle and small, the sagittal diameter is less than 5mm Because the front of the vertebral body is loose connective tissue and elastic esophagus, the buffer gap is large, so the symptoms are generally not present, but it is easy to cause compression if the following conditions occur.
1. The spur is too large: if the spur is too large (the author encounters more than 1.5cm) and exceeds the anterior vertebral space and the cushioning and compensatory capacity of the esophagus itself, symptoms of esophageal compression may occur.
2. Rapid formation of bone spurs: If the spurs of the vertebral body are rapidly formed due to trauma and other factors, the length is smaller than that of the former. However, due to the inability to adapt and compensate for the soft tissue, the local balance is imbalanced and symptoms are prone to occur.
3. Esophageal abnormalities: clinically, there are cases of spurs that are only 4 to 5 mm long, which are symptoms of dysphagia. This is mainly due to the presence of inflammation (or inflammation around the esophagus) in the esophagus itself, and of course the spirit of the patient. Factors, esophageal activity and local response are directly related.
4. Characteristics of the anatomical part: the presence or absence of symptoms and the appearance of morning and evening, the degree and the like are closely related to the segment of the esophagus. The annular cartilage (equivalent to the sixth cervical vertebra) and the esophagus of the aponeurosis are relatively fixed, so the smaller spur is Can cause symptoms.
5. Positional influence: When the cervical vertebra is in the upright position, the esophagus is easily tightened due to the tension of the esophagus. When the neck is flexed, the esophagus is in a relaxed state, so it is easy to pass through the food.
Prevention
Esophageal compression cervical spondylosis prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Complications of esophageal compression cervical spondylosis Complications, peptic ulcer
There may be a swallowing disorder.
Symptom
Esophageal compression cervical spondylosis symptoms Common symptoms Shoulder and back heavy feeling neck and shoulder pain Cervical deformity Cervical disc degeneration Anterior scale hypertrophy Spinal nerve compression Neck dysphagia Dysphagia Dysphagia
1. Dysphagia:
In the early stage, there was a sense of difficulty in swallowing hard foods and an abnormal feeling behind the sternum after eating (burning, tingling, etc.), which gradually affected the swallowing of soft food and liquid diet. The degree of dysphagia can be divided into:
(1) Mild: It is an early symptom, which is manifested as difficulty in swallowing when the neck is raised, and disappears when the neck is bent.
(2) Moderate: refers to those who can swallow soft food or liquid diet, more common, and more patients come to see.
(3) Heavy: only water, soup, but rare.
2. Other cervical spondylosis symptoms:
Patients with simple esophageal compression cervical spondylosis are rare, and about 80% of cases are accompanied by spinal cord, spinal nerve root or vertebral artery compression symptoms, so they should be thoroughly examined to find other symptoms.
Examine
Examination of esophageal compression cervical spondylosis
1. X-ray film inspection:
It shows the formation of spurs on the anterior edge of the vertebral body. The typical shape is a bird's beak. The most common site is the neck 5~6, the neck 6~7 and the neck 4~5. The esophageal compression range is about half of the cases. Up to 2 intervertebral spaces.
2. Barium meal check:
In the fluoroscopy of the meal (or the film), the location and extent of the esophageal stenosis can be clearly displayed. The degree of esophageal stenosis is proportional to the size of the epiphysis, and is related to the position of the cervical vertebra. When the neck is flexed, the esophagus In the relaxed state, the expectorant is easy to pass, and the lighter does not even show the stenosis; but when the neck is in the neck, the esophagus is in a state of tension and being stretched, so that the sputum is increased through the obstacle.
3. MRI and CT examination:
It can show the pathological changes of the vertebral joints, including the formation of anterior and posterior sphenoids and the effect on the esophagus.
Diagnosis
Diagnosis and diagnosis of esophageal compression cervical spondylosis
diagnosis
1. Dysphagia: Early fear of swallowing dry food, the symptoms of the neck flexion are lighter, and the weight is increased when it is stretched.
2. Imaging examination: including X-ray plain film and barium meal examination, etc., can show the formation of callus in front of the vertebral ganglia, and compression of the esophagus caused by stenosis and stenosis, if necessary, MRI and other tests.
3. Other diseases should be excluded: refers to esophageal cancer, sputum sputum, gastroduodenal ulcer, snoring and esophageal diverticulum, etc. If necessary, MRI or fiber esophagoscopy can be used, but it should be noted that in the case of spurs, Fiber esophagoscopy has the risk of esophageal perforation (reported in the literature): the neck should not be stretched during the insertion of the fiber esophagoscopy to prevent spinal cord hyperextension injury.
Differential diagnosis
Esophagitis
Primary is rare, mostly due to stab wounds, bones and other stab wounds when swallowing, so it is easy to distinguish from the anterior margin of the vertebral body. If the individual causes are unclear, the diagnosis is difficult, you can take the cervical X-ray. When the tablet is flat, the tincture is swallowed to determine the cause of obstruction of the esophagus.
2. Esophageal cancer
The incidence is slow, more common in the elderly, so it is easy to be confused with esophageal compression cervical spondylosis, X-ray barium meal examination and fiber esophagoscopy is easy to confirm.
