The neck is afraid of bending forward and stretching back
Introduction
Introduction Cervical spinal stenosis neck defense: These patients often maintain the neck in the natural position (function position), can be flexed, afraid of stretching. 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.
Cause
Cause
(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 laminar hypertrophy, short pedicle, small joint hypertrophy or growth in the direction of the spinal canal. Hypertrophy is also associated with innate development.
(two) pathogenesis
1. Innate developmental factors: congenital developmental factors are mainly achondroplasia. This cause is more common in the clinic and is a major factor in the pathogenesis. Through observations of thousands of surgical cases, the authors found that such factors have a certain relationship with families and regions, and 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 inner 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 type of patient is likely to irritate the spinal cord tissue in the spinal canal when he encounters some secondary factors, including traumatic edema, unstable vertebral ganglia, nucleus pulposus (or prolapse) and spur formation. Neurological symptoms. The smaller the sagittal diameter of the patient, the heavier the condition; the larger the pressure, the more obvious the symptoms. On this basis, if the patient is accompanied by ossification of the posterior longitudinal ligament or other pathological anatomical factors, not only the disease is serious, but the treatment is difficult and the prognosis is poor.
2. Acquired general additional factors refer to the displacement of the intervertebral joints, the posterior small joints and the hook joints due to the loosening and instability of the vertebral nodes. In the case of a small degree of displacement, although it can have no effect on a large spinal canal, in the case of spinal canal stenosis, the stimulation or compression symptoms 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. Different from the former: this factor and developmental spinal stenosis together constitute a direct cause of its pathogenesis, and has a persistent characteristics; in general, non-surgical treatment is often difficult to eradicate.
Examine
an examination
Related inspection
Cervical activity examination cervical CT examination
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 and prolapse And the formation of osteophytes, but also the predisposing factors of 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. Through a large number of cases, 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 as numbness of the limbs, skin allergies or sensory separation, which is mainly due to the involvement of the spinal thalamus bundle and other sensory nerve fiber bundles. 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, which is related to various predisposing factors. A remission period can occur after treatment with non-surgical therapy.
2. Movement disorders: more than a few weeks or months after the onset of sensory symptoms, most of which were found during the examination. The main manifestation is the pyramidal tract sign. The patients start from the symptoms of heavy gait, weakness of the lower limbs, difficulty in lifting, easy to trip and banding, and the symptoms become more and more aggravated with the development of the disease course.
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 extensive. 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, it is often the simultaneous emergence of several segments. At the time of examination, the plane generally does not exceed the innervation area of the highest segment of the spinal canal stenosis, which is significantly different from the level of muscle atrophy in the lateral sclerosis of the spinal cord to above the level of the neck 2 .
Diagnosis
Differential diagnosis
Need to be identified with the following symptoms:
The neck is stiff: the neck, shoulders and occipital pain, accompanied by the corresponding tender points and the neck is stiff, which is the clinical feature of cervical spondylosis. Cervical cervical spondylosis, also known as ligamentous joint capsule cervical spondylosis, is often referred to as "slipping pillow" in acute attacks.
Can not turn neck: can not turn neck is the clinical manifestations of the atresia syndrome. The atresia syndrome, also known as the atresia syndrome, is the efferent state, which is caused by the basal lesion of the pons. Mainly seen in the cerebral vasculopathy, mostly bilateral occlusion of the basilar artery pons, resulting in bilateral infarction at the base of the pons.
Neck stiffness: Neck stiffness is an important objective sign in meningeal irritation. It is mainly characterized by different degrees of muscle rigidity, especially extensor muscles. The head flexion is obviously limited, that is, the passive flexion neck encounters resistance, and the head side bend is also affected. With certain restrictions, the head rotation movement is limited to light, and the head back is not strong. Found in various types of meningitis, subarachnoid hemorrhage, increased intracranial pressure, cervical disease and so on.
