Occipital and back pain
Introduction
Introduction Frequent occipital pain is mostly associated with insufficient blood supply to the vertebral basilar artery, and the cause of it is mainly cervical spondylosis. Cervical spondylosis refers to a disease caused by cervical spine degeneration and deformation and stenosis of the cervical spinal canal or intervertebral foramen, which stimulates and compresses the cervical spinal cord and nerve roots and causes corresponding clinical symptoms. This disease is more common in patients over 40 years old.
Cause
Cause
The basic pathological change of cervical spondylosis is the degeneration of the intervertebral disc. The cervical vertebra is located between the skull and the thorax. The cervical disc has frequent activities under load-bearing conditions and is susceptible to excessive micro-injury and strain.
The main pathological changes are: early cervical disc degeneration, decreased water content of the nucleus pulposus and fibrous swelling and thickening of the annulus fibrosis, followed by glassy degeneration and even rupture. After cervical disc degeneration, the pressure resistance and tensile strength are reduced. When subjected to the gravity of the skull and the pulling force of the muscles of the head and chest, the degenerated disc can undergo localized or extensive bulging to the periphery, narrowing the intervertebral disc space, overlapping the articular processes, dislocation, and the longitudinal diameter of the intervertebral foramen. Become smaller. As the traction resistance of the intervertebral disc becomes weaker, when the cervical vertebra moves, the stability between adjacent vertebrae decreases and the intervertebral instability occurs, the mobility between the vertebral bodies increases and the vertebral body has a slight slippage, which then appears Bone hyperplasia of the posterior facet joint, hook joint and lamina, degeneration of the ligamentum flavum and ligament, cartilage and ossification.
Because the cervical disc bulges around, the surrounding tissues (such as the anterior and posterior longitudinal ligaments) and the vertebral periosteum can be picked up, and a gap is formed between the vertebral body and the protruding intervertebral disc and the ligament tissue that is picked up. The gap ", in which the accumulation of tissue fluid, coupled with the bleeding caused by the micro-damage, makes this bloody fluid mechanized and then calcified, ossified, thus forming the epiphysis.
The relaxation of the anterior and posterior ligaments of the vertebral body makes the cervical spine unstable, which increases the chance of trauma and gradually increases the callus. The epiphysis together with the bulging annulus fibrosus, the posterior longitudinal ligament and the edema or fibrous scar tissue caused by the traumatic reaction, forming a mixture in the spinal canal at the site corresponding to the intervertebral disc, may exert an oppressive effect on the spinal nerve or the spinal cord. The epiphysis of the hook joint can protrude from the anterior to the posterior to the intervertebral foramen to compress the nerve root and the vertebral artery. The epiphysis of the anterior border of the vertebral body generally does not cause symptoms, but there are reports of such anterior epiphysis affecting swallowing or hoarseness in the literature. After the spinal cord and nerve roots are compressed, they are only functional changes at the beginning. If the pressure is not relieved in time, it will gradually produce irreversible changes. Therefore, if non-surgical treatment is ineffective, surgery should be performed promptly.
[Pathogenesis]
The pathogenesis of cervical spondylosis:
1. Degenerative changes of the cervical spine.
2. Trauma factors.
3. Chronic strain.
4. Cold and humid.
Additional instructions:
Cervical spondylosis is mainly caused by degenerative changes in the cervical disc and cervical vertebrae and their accessory structures.
The pathogenesis of cervical spondylosis, like lumbar disc herniation, cannot be explained by mechanical compression alone, and vascular and chemical factors are at work, causing edema and inflammation or aggravating neurological symptoms.
Examine
an examination
Related inspection
Cervical MRI examination cervical CT examination
The symptoms of cervical spondylosis are very rich, diverse and complex. Most patients begin to have milder symptoms, which gradually worsen later, and some of them have more severe symptoms. This is related to the type of cervical spondylosis, but often the type is simple, with one type as the main cum and one to several types mixed together, called mixed cervical spondylosis, so the symptoms are very rich and diverse. complicated.
Its main symptoms are sore head, neck, shoulders, back, arms, neck and neck, and limited mobility. Neck and shoulder pain can be radiated to the head and upper parts of the head, some with dizziness, house rotation, severe with nausea and vomiting, bedridden, a few can have dizziness, tripping. Some of the face is hot, and sometimes sweating is abnormal. The shoulders and back are heavy, the upper limbs are weak, the fingers are numb, the skin of the limbs is weakened, the grip is weak, and sometimes the unconscious grip falls. Other patients have weak limbs, unstable walking, numb feet, and feeling like walking cotton when walking. When cervical spondylosis involves sympathetic nerves, dizziness, headache, blurred vision, dilated eyes, dry hair, open eyes, tinnitus, ear plugs, balance disorders, tachycardia, palpitation, chest tension, and some There are even symptoms such as flatulence. A small number of people have large, urinary out of control, sexual dysfunction, and even quadriplegia. Also have difficulty swallowing, dysphonia and other symptoms.
These symptoms have a certain relationship with the degree of onset, the length of onset, and the physical condition of the individual. Most of them are light and not taken seriously by people. Most of them can recover on their own, and they are light and heavy. Only when the symptoms continue to increase and cannot be reversed, it will only attract attention when it affects work and life. If the disease is cured for a long time, it will cause psychological damage, resulting in insomnia, irritability, anger, anxiety, depression and other symptoms.
The clinical symptoms of cervical spondylosis are more complicated. Mainly neck pain, upper limb weakness, finger numbness, lower limb weakness, difficulty walking, dizziness, nausea, vomiting, and even blurred vision, tachycardia and difficulty swallowing. The clinical symptoms of cervical spondylosis are related to the location of lesions, the degree of tissue involvement and individual differences.
Diagnosis
Differential diagnosis
Differential diagnosis of occipital and posterior neck pain:
1, chronic pain in the head pillow: occipital neuralgia refers to the pain in the distribution of the posterior head occipital nerve and occipital nerve. The occipital and neck sensation is dominated by the first, second, and third pairs of cervical nerves, and the posterior branch of the second cervical nerve constitutes the occipital nerve. The medial line from the midpoint of the mastoid and the posterior midline of the first cervical vertebra is deep. Shallow, distributed in the posterior occiput is equivalent to the part of the external ear canal after the head and neck are connected. The anterior branch of the third cervical nerve constitutes the occipital small nerve and the auricular nerve. The occipital nerves are mainly distributed in the upper part of the auricle and the skin outside the occipital. The large ear nerves are mainly distributed in the anterior and posterior parts of the lower auricle, the surface of the parotid gland and the mandibular angle. When the three nerves are involved, it can cause pain in the posterior occipital and neck, and often occurs in the form of neuralgia. Because the posterior root of the first cervical nerve is generally small, the posterior occipital and neck pain caused by the upper cervical spinal nerve disease is collectively called occipital neuralgia. Frequent occipital pain is mostly associated with insufficient blood supply to the vertebral basilar artery, and the cause of it is mainly cervical spondylosis.
2, head and neck pain: head and neck pain is one of the characteristics of tension headache. Tension headache, also known as muscle contraction headache, is the most common type of headache. It is generally considered to have a higher prevalence than migraine, accounting for about half of all outpatient headaches. Mainly for the neck and head and face muscles, the head pressure and heavy feeling caused by the continuous contraction, and some patients complained that the head has a "tight" feeling.
The symptoms of cervical spondylosis are very rich, diverse and complex. Most patients begin to have milder symptoms, which gradually worsen later, and some of them have more severe symptoms. This is related to the type of cervical spondylosis, but often the type is simple, with one type as the main cum and one to several types mixed together, called mixed cervical spondylosis, so the symptoms are very rich and diverse. complicated.
Its main symptoms are sore head, neck, shoulders, back, arms, neck and neck, and limited mobility. Neck and shoulder pain can be radiated to the head and upper parts of the head, some with dizziness, house rotation, severe with nausea and vomiting, bedridden, a few can have dizziness, tripping. Some of the face is hot, and sometimes sweating is abnormal. The shoulders and back are heavy, the upper limbs are weak, the fingers are numb, the skin of the limbs is weakened, the grip is weak, and sometimes the unconscious grip falls. Other patients have weak limbs, unstable walking, numb feet, and feeling like walking cotton when walking. When cervical spondylosis involves sympathetic nerves, dizziness, headache, blurred vision, dilated eyes, dry hair, open eyes, tinnitus, ear plugs, balance disorders, tachycardia, palpitation, chest tension, and some There are even symptoms such as flatulence. A small number of people have large, urinary out of control, sexual dysfunction, and even quadriplegia. Also have difficulty swallowing, dysphonia and other symptoms. These symptoms have a certain relationship with the degree of onset, the length of onset, and the physical condition of the individual. Most of them are light and not taken seriously by people. Most of them can recover on their own, and they are light and heavy. Only when the symptoms continue to increase and cannot be reversed, it will only attract attention when it affects work and life. If the disease is cured for a long time, it will cause psychological damage, resulting in insomnia, irritability, anger, anxiety, depression and other symptoms.
The clinical symptoms of cervical spondylosis are more complicated. Mainly neck pain, upper limb weakness, finger numbness, lower limb weakness, difficulty walking, dizziness, nausea, vomiting, and even blurred vision, tachycardia and difficulty swallowing. The clinical symptoms of cervical spondylosis are related to the location of lesions, the degree of tissue involvement and individual differences.
[clinical classification]
1, neck type:
1 The main complaints of head, neck and shoulder pain, etc., accompanied by corresponding tender points.
The 2X line upper cervical vertebra showed changes in curvature or intervertebral joint instability.
3 should exclude other diseases of the neck (shoulder, periarthritis, rheumatoid myofasthenia, neurasthenia and other non-intervertebral disc degeneration caused by shoulder and neck pain).
2, nerve root type:
1 has more typical root symptoms (numbness, pain), and the range is consistent with the area dominated by the cervical spinal nerve.
2 Indenter test or brachial plexus pull test is positive.
3 The findings of imaging are consistent with clinical manifestations.
4 pain point closure is not effective (can not be diagnosed if the diagnosis is clear).
5 Excluding cervical extra-vertebral lesions (thoracic outlet syndrome, tennis elbow, carpal tunnel syndrome, cubital tunnel syndrome, frozen shoulder, biceps tenosynovitis, etc.) caused by upper extremity pain.
3. Spinal cord type:
1 clinical manifestations of strong cervical spinal cord damage.
2X-ray showed the posterior marginal vertebral hyperplasia and spinal stenosis. Imagery confirms the presence of spinal cord compression.
3 Excluding muscle atrophic spinal cord scoring, spinal cord tumor, spinal cord injury, secondary adhesive arachnoiditis, multiple peripheral neuritis.
4, vertebral artery type: the diagnosis of vertebral artery type cervical spondylosis is a problem to be studied.
1 had a stumble attack. And accompanied by cervical vertigo.
2 The neck test was positive.
3X line shows segmental instability or bone hyperplasia of the joint.
More than 4 with sympathetic symptoms.
5 Excluding eye-derived, otogenic vertigo.
6 Excluding the vertebral artery segment I (the vertebral artery segment before entering the neck 6 transverse process) and the vertebral artery segment III (the cervical vertebrae entering the intracranial vertebral artery segment) under pressure caused by basilar artery insufficiency.
7 vertebral angiography or digital subtraction vertebral artery angiography (DSA) is required before surgery.
5, sympathetic type: clinical manifestations of dizziness, vertigo, tinnitus, hand numbness, tachycardia, pain in the precordial area and other sympathetic symptoms, x-ray film instability or degeneration. Vertebral angiography negative.
6, other types: cervical vertebral body anterior ovary-like hyperplasia oppression caused by dysphagia (via esophageal sputum examination confirmed) and so on.
