vertebral artery type cervical spondylosis
Introduction
Introduction to vertebral artery type cervical spondylosis Vertebral artery type cervical spondylosis is slightly more common than cervical spondylotic myelopathy, because most of them are caused by unstable vertebral nodes, and the non-surgical treatment is better or better. Therefore, there are fewer hospitalizations and those requiring surgery. This type mainly causes headache. Symptoms, it is also called ascending cervical spondylosis, and it is easy to be confused with a variety of headache-causing diseases. It is often difficult to diagnose before vertebral artery imaging examination. Therefore, its diagnosis problem often becomes controversial among related departments. The problem. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: insomnia, neurasthenia, memory impairment
Cause
Causes of vertebral artery type cervical spondylosis
Dynamic factor (50%):
Mainly due to instability of the vertebral joints, the hook joints are loose and displaced, affecting the upper and lower transverse holes on both sides, resulting in axial or lateral displacement, stimulating or compressing the vertebral artery and causing paralysis, stenosis or flexion changes. Most of these factors are most common in early stage. In addition, the change of the intervertebral space also affects the vertebral artery, because at the same time as the intervertebral space degenerates, the distance between the upper and lower vertebral bodies becomes shorter, resulting in the same The vertebral artery of the segment grows relatively, which not only directly destroys the original balance between the vertebral artery itself and the cervical vertebral bone, but also makes it easy to change the flexion, stenosis and bending, as long as the internode height is restored (for example, by traction) ), this phenomenon can quickly disappear.
Mechanical factors (30%):
Mainly due to continuous pressure on the body.
(1) Traumatic response of the hook joint capsule: The traumatic reaction at the small joint capsule behind the vertebral joint mainly affects the spinal nerve root, while the swelling of the synovial membrane of the hook joint wall, congestion and exudation is directly reduced by the transverse protrusion The transverse diameter (more important for the vertebral artery than the sagittal diameter) and the vertebral artery can cause paralysis, flexion or stenosis of the artery due to local irritation or compression.
(2) uncinate bone hyperplasia: in the cervical joints, the hook joint is one of the earliest sites of degeneration, so bone hyperplasia is also more common, the hyperplastic bone spurs except the direct compression of the lateral spinal nerve, the vertebral artery also It is easy to be compressed, and the osseous tube of the transverse protrusion makes the vertebral artery lose the room for retreat and avoidance, which constitutes one of the main pathological anatomical features of the disease. The part of the skeletal hyperosteogeny is the predilection site of the cervical vertebra degeneration. More common, that is, neck 5 ~ 6, neck 6 ~ 7 and neck 4 ~ 5; but in recent years, it is not uncommon to find the neck 3 ~ 4.
(3) nucleus pulposus detachment: due to the occlusion of the posterior vertebral body, the nucleus pulposus in the intervertebral space is not easy to protrude from the spinal nerve or vertebral artery, but when it penetrates the posterior longitudinal ligament of the posterior margin of the vertebral body In the spinal canal, it is possible to reach the intervertebral foramen, which affects the vertebral artery while compressing the spinal nerve root.
Vascular factors (20%):
(1) abnormal vascular dynamics: This disease is more common in middle age, in addition to the degeneration of the cervical spine itself, blood vessels also appear aging, especially in cases over 50 years old, mainly the elastic retractive force of the blood vessels itself is weakened. This phenomenon is also related to the large amount of activity of the cervical vertebrae, especially the rotation, flexion, etc., which cause the vertebral artery to be pulled, thus accelerating the degeneration and aging of the blood vessels.
(2) arteriosclerotic changes: the result of abnormal pathological changes in vascular dynamics. Even in normal people, after 50 years of age, the systemic arteries can have different degrees of sclerosing changes, and the vertebral artery is no exception, the degree and age. In proportion, if atheromatous plaques appear on the vessel wall (the vertebral artery is one of the most common sites), this pathological process can be accelerated.
(3) Vascular variability: Anatomical materials indicate that vertebral artery and vertebral vein (plexus) are prone to variability, including the separation of transverse acupoints (a few can be divided into 2 to 3), sagittal diameter and transverse diameter change, and the difference in blood vessel number The asymmetry of the blood vessels on both sides and the different sizes of the calibers have a certain relationship with the occurrence and development of the disease.
Prevention
Vertebral artery type cervical spondylosis prevention
1. Strictly prevent acute head, neck and shoulder injuries:
Head and neck falls, bumps and whiplashes are prone to cervical and soft tissue damage, directly or indirectly cause cervical spondylosis, it should be actively prevented, should be promptly inspected and thoroughly treated. Some traumas are easy to attract people's attention, such as sleeping and sleeping, encountering sudden braking, head suddenly reclining, can cause whiplash injury in the cervical vertebrae; when someone is angry, they can twist the child's ears at will, and the child will acutely twist the neck for defense. Or use the slap to hit the child's back head, etc., can cause damage to the neck muscle and surrounding soft tissue; infants and young children's neck muscles are not developed, the neck is soft, such as prematurely lifting or holding the child's posture is not suitable, it is easy to cause overstretching Sexual cervical spine injury; some adolescent sports can not or do not pay attention to pre-sport preparation activities, such as top cattle, head standing, front rollover and neck riding entertainment, etc., can cause sports injuries. Prevention of trauma is a powerful measure to prevent degeneration of the spine. In the event of trauma, in addition to the treatment of soft tissue damage, it is also necessary to treat the cervical facet joint dislocation in time to prevent the development of cervical spondylosis.
2. Correct bad postures in life and prevent chronic injuries:
Chronic strain of neck and shoulder soft tissue is the pathological basis of cervical spondylosis. The bad posture in life is one of the main reasons for the formation of chronic strain, so correcting the bad posture in daily life is of great significance for the prevention of cervical spondylosis. . For example, some people like to lie on their backs. In order to breathe, they can only turn their heads to one side, which will cause 1~4 cervical sprains. When the neck axis is bent, when it reaches decompensation, it will cause dizziness, headache and symptoms such as eyes, ears and nose and throat. Due to the damage of the normal mechanical imbalance of the cervical vertebrae, the intervertebral disc degeneration of each cervical vertebra will be accelerated; some people usually have a good posture, but when reading novels and watching TV, they are used to leaning their heads on the bed rails or on the armrests of the sofa, causing the neck to bend back and twist. Etc., this will cause instability of the spine due to spinal intervertebral ligament injury; women take the child to sleep, often facing the child on the side, if the pillow does not fit the height of the body, the cervical thoracic vertebra will be placed in a forced position, forming a side bend, which can lead to the spine disease.
3. Reasonable use of pillows:
Pillow is a protective tool for the neck column. An adult sleeps 6~9 hours a day, that is, 1/4~1~3 times a day is spent in sleep (pillows), so the pillow must fit the neck. Physiological requirements. After a person is asleep, the neck and shoulder muscles are completely relaxed. The elasticity of the intervertebral ligament and the joint capsule is only used to maintain the normal relationship of the intervertebral structure. If the height of the pillow is not used for a long time, the cervical vertebra will be flexed excessively. Here, the ligaments and joint capsules are stretched and damaged, which causes instability of the cervical vertebrae, joint dislocation, and development of cervical spondylosis. Such patients often present with symptoms such as neck discomfort, stiff neck, dizziness, headache or intractable insomnia in the morning after sleep or wake up. A reasonable pillow is very important for the treatment and prevention of cervical spondylosis. It is not a substitute for medical treatment, but it should be applied for a long time. A reasonable pillow must have two items: a scientific height and a comfortable hardness. For the height of the pillow, scholars at home and abroad attach great importance to it and propose a variety of data. Our research suggests that pillows should not be too high or too low. Most people use their own shoulder line (the distance from the mandibular angle to the acromion) or the lateral diameter of the palm as the height of the side or supine. This height is suitable for most people; a few people need appropriate high pillows, such as spinous processes. Malformations, kisses, and low pillows can make the symptoms worse. The pillow should have appropriate elasticity or plasticity. Don't be too hard. It is better to use kapok or grain husk, and it can form a saddle shape after application.
Good sleep is important for the health of the spine. The lateral diameter of the trunk, shoulders and pelvis of the human body is large. When the side is lying, the spine is bent by the influence of the mattress. If the lateral position is biased for a long time, the spine will gradually bend, and the back will be stiff and discomfort after waking up. It is necessary to get up to resume normal, and the severe one can develop into spinal disease. Sleep should be mainly on the back, supplemented by the side, alternating left and right, and the left and right knees are slightly opposite each other when lying on the side. Prone, semi-prone, semi- supine or upper and lower body torsion and sleep, are all bad sleeping posture, should be corrected in time. The head should be placed in the center of the pillow to prevent the pillow from falling. Patients with spondylosis should use a wooden bed, and the spring bed is not beneficial to the physiological balance of the spine.
4. Prevention of chronic strain:
Due to work needs, some types of work require special postures or work in forced positions for a long time. If they are not taken seriously, they are prone to chronic strain and gradually develop into spinal disease. For example, long-term microscope personnel, tunnel operators, accountants, sewing embroidery, dentists, aircraft mechanics, typists, hairpins, etc., neck, torticollis, neck-neck, shrug workers, and long-term desk work If you don't pay attention to the height of the table and chair and your body size, and don't pay attention to the balance movement in your spare time (the posture exercise opposite to the working posture, such as the desk worker doing the lazy movement), the shoulder will take place for a long time. Soft tissue load in the neck is not only prone to low back soft tissue strain, but also can be further developed into cervical, thoracic and lumbar joint dysfunction. To prevent chronic strain, in addition to balancing exercise in the workplace or in spare time, you can also choose certain sports according to different ages and physical conditions to enhance muscle strength and enhance physical fitness.
Complication
Vertebral artery type cervical spondylosis complications Complications, insomnia, neurasthenia, memory impairment
1, stubborn insomnia, neurasthenia: more than 70% of people with this disease have cervical spondylosis. Many patients and doctors just treat insomnia.
2, repeated episodes of dizziness: mainly caused by vertebral artery compression, if you work in high places, walking along the river, driving on the road, the machine suddenly fainted when operating, it will bring very serious consequences.
3. Severe memory loss.
Symptom
Vertebral artery type cervical spondylosis symptoms Common symptoms Dizziness pre-slanted muscle hypertrophy sensory disorder
1, vertigo:
Most common, almost every patient has a dizzy feeling of varying degrees of weight, often accompanied by diplopia, nystagmus, tinnitus, deafness, nausea and vomiting. At the time of the attack, the patient felt top-heavy and unstable, as if the subject and the surrounding scenery were rotating in a certain direction; some patients felt that they and the ground had a sense of movement, tilt and swing. Often in the head activities, such as head up, suddenly turning around or repeatedly turning around the head, dizziness or dizziness occurs, severe cases can occur syncope or coma. Some patients can only turn their heads to one side, and the heads turn to the opposite side, which is easy to cause seizures. Turning to the opposite side can also reduce the symptoms. Some patients complain that they are watching the blackboard while they are taking notes. In short, head and neck activity and posture changes induce or aggravate vertigo is an important feature of this disease.
2, stumble:
It is a symptom that is unique to this type. Some occur when the vertigo is intense or the neck is active. The patient can suddenly feel numbness, weakness and fall, but he is conscious and can get up on his own. This symptom is associated with sudden head movement or posture changes. Some people think that it is caused by medullary olivary ischemia, and some people think that it is caused by sudden ischemia at the intersection of vertebral bodies.
3, headache:
It is a vascular headache caused by insufficient blood supply to the collateral-basal arteries leading to collateral circulation of the collateral vessels, which is episodic, lasting for a few minutes or hours, or even days. Pain is persistent and often occurs or worsens in the morning, in the head, in the bumps. Most of the headaches are located in the occiput, the top of the pillow or the ankle. It is a painful (pulsating pain), burning or painful pain. It can be radiated to the back of the ear, face, teeth, top of the pillow, even to the eyelid area and the base of the nose. Symptoms of autonomic dysfunction such as nausea, vomiting, sweating, hooliganism, palpitation, belching, and changes in blood pressure can occur during the attack. Individual cases have facial, hard palate, tongue and throat pain, numbness, itching or foreign body sensation. Therefore, similar to the performance of migraine, some people call it cervical migraine.
4, eye symptoms:
Such as fog, flashing eyes, dark spots, transient black sputum, temporary visual field defects, vision loss, diplopia, visual hallucinations and blindness, these eye symptoms are mainly caused by ischemia of the posterior cerebral artery. Visual impairment is mainly caused by visual central ischemia of the occipital lobe of the brain, so it can be called cortical visual impairment. The third, fourth, and sixth cranial nerve nucleus and medial longitudinal sac ischemia can cause diplopia. In addition, since the vertebral artery is connected to the internal carotid artery system by the posterior communicating artery, it can reflexively cause retinal artery spasm and cause eye pain and changes in fundus vascular tone. In the attack period, the fundus vein dilatation and arterial thinning are particularly common, especially when the neck is overextended. Individual patients can cause vasospasm retinitis. It has also been reported that some patients may have symptoms and signs such as eyelids, conjunctival hyperemia, corneal sensation, ulceration, lacrimal gland secretion disorder, retrobulbar optic neuritis, exophthalmos, glaucoma and Horner's sign.
5, medullary paralysis and other cranial nerve symptoms:
Such as unclear language, dysphagia, disappearance of pharyngeal reflex, drinking water, phlegm, hoarseness, tongue distraction, eye muscle twitching and facial nerve paralysis.
6, feeling the obstacles:
There may be facial, perioral, tongue, limbs or half-length numbness, some with acupuncture, ant feeling, and some may have deep sensory disturbances.
From the above performance, the symptoms of this disease are many and very mixed, but diagnosis can still be made according to physical examination, x-ray and cerebral blood flow chart examination. When the disease occurs, the vertigo is serious and it is easy to fall. Therefore, it is appropriate to take a supine rest during the attack, and the pillow should be lowered to reduce the cervical vertebra activity. In addition, it is especially necessary to prevent tripping from causing new damage.
Examine
Examination of vertebral artery type cervical spondylosis
1.X-ray change
In addition to the characteristics of cervical cervical spondylosis (vertebral instability and column line changes), abnormalities such as hyperplasia of the sacral vertebrae, narrow intervertebral foramen (oblique slices) and vertebral deformities can be found, and attention should be paid to the presence or absence of observation. Other abnormalities (post-sternal thyroid tumor or other tumors, the trachea can be pressed to one side, although rare, but the consequences are serious, the author has found 2 cases), between the skull base and the first cervical vertebra, the first and second cervical vertebrae Whether there is instability (can be observed from the dynamic lateral radiograph, the skull base and the atlas instability indicate the third segment of the vertebral artery), and whether there is a skull base depression (the third segment of the vertebral artery can be involved), above Points are important for differential diagnosis and must be observed.
2.DSA technology
Through the femoral artery puncture and insertion catheter, a small amount of contrast agent is injected, and the clear vertebral artery image obtained by digital subtraction imaging technology is not only for diagnosis, but also crucial for the determination of the surgical site, and should be pursued.
3.MRI imaging technology
It is of great significance to determine whether there is variability in the state of the spinal cord and the transverse acupoints on both sides, whether it is symmetrical or not, especially the non-invasive vertebral artery MR imaging technique (MRA). The diagnosis of the vertebral artery is safe and diagnostic. Value, MRA technology is worse than DSA technology, but from a clinical point of view, more than 90% of patients are willing to undergo MRA examination, and are not willing to perform DSA examination.
4. Other
Including traditional vertebral angiography, CT examination, etc. can be used as appropriate.
Diagnosis
Diagnosis and diagnosis of vertebral artery type cervical spondylosis
Diagnostic points :
1. There is a vertebral-basal artery ischemic sign (mainly vertigo) and/or a history of cataplexy.
2. The cervical spine induction test is positive.
3. X-ray films show instability of the intervertebral joint or hyperosteogeny of the hook joint.
4. Generally have obvious sympathetic symptoms.
5. Excluding eye-borne and otogenic vertigo.
6. The basilar artery insufficiency caused by compression of the first segment of the vertebral artery (the vertebral artery before entering the transverse cervical process of the sixth cervical vertebra).
7. Excluding neurosis and intracranial tumors.
8. The diagnosis of this disease, especially preoperative positioning, should be based on MRA, DSA or vertebral angiography results; vertebral artery blood flow map and cerebral blood flow map have only reference value, should not be used as a diagnostic basis.
Differential diagnosis
Inner ear disease
(1) Overview: The so-called inner ear disease mainly refers to Meniere's disease, which is caused by local edema caused by blocked lymphatic drainage in the inner ear. The disease has the following three characteristics in clinical practice: paroxysmal vertigo, volatility, progressiveness and sensation. Hearing loss, tinnitus.
(2) Identification points: Since patients with vertebral artery type cervical spondylosis may also have symptoms similar to the above, it is necessary to distinguish the two. In fact, if the specialist performs a specialist examination on the vestibular function of the inner ear, it is not difficult to exclude Anyone diagnosed with vertebral artery type cervical spondylosis should be consulted by an otologist in order to exclude otogenic vertigo. In addition, MRA, DSA and other tests are helpful for the identification of both.
2. Ocular vertigo
(1) Overview: Most of the disease is caused by ophthalmoplegia and refractive error (especially astigmatism), and the incidence rate among adolescents is particularly high, so it should be noted.
(2) Identification points: The main basis for the identification of this disease and cervical vertigo:
1 Closed eyes are difficult to sign negative.
2 The eye-based nystagmus test was mostly abnormal.
3 ophthalmic examination has refractive error, which is more common with astigmatism.
4 closed eyes and neck test negative.
3. Intracranial tumor
The disease is directly compressed by the vestibular nerve or central connection of the tumor tissue. In addition to the symptoms of vertigo in the clinic, it is often accompanied by other symptoms such as increased intracranial pressure. If clinical attention can be paid, it is generally not difficult to be associated with cervical vertigo. Identification, MRI or CT examination is feasible for individuals with difficult identification.
Arteriosclerosis
Mainly due to the hardening of the vertebral artery itself (more with hypertension), the pathological changes may be nodular, except for thickening of the wall, hardening and loss of elasticity or disappearance. Because the symptoms can be similar to those of cervical vertebral artery insufficiency, it is necessary to diagnose according to MRA, DSA or vertebral artery angiography. Of course, long-term history of hypertension can be used as a reference.
5. Posterior mass of the sternum
The posterior mass of the sternum is more common with tumor and retrosternal goiter. It can directly compress the first segment of the vertebral artery and cause symptoms of vertebral artery insufficiency. The diagnosis can be based on the presence or absence of cervical vertebrae abnormalities, cervical vertigo and other cervical vertebrae. In addition to the symptoms of the disease, the diagnosis still needs to be based on DSA, MRA or vertebral angiography.
6. Other
In addition to the above five lesions, all other symptoms that can cause dizziness need to be identified, including:
(1) Toxic vertigo in drugs: Streptomycin poisoning is more common.
(2) Epidemic vertigo: It is a group-like phenomenon, which is related to war, natural disasters and unexpected emergencies. It is mostly transient and has a good prognosis.
(3) Postural vertigo: caused by anemia or prolonged bed rest.
(4) Injury vertigo: can be caused by trauma to the inner ear, the auditory nerve and the central vestibular nucleus.
(5) Neurosis: Caused by long-term insomnia.
If the above diseases can be checked, it is not difficult to diagnose.
