cervical spinal stenosis
Introduction
Introduction to cervical spinal stenosis The anatomical structure of the cervical spinal canal is caused by developmental or degenerative factors, causing bone or fibrous degeneration to cause one or more flat lumen stenosis, resulting in spinal cord dysfunction, spinal cord and nerve root compression are cervical spinal stenosis . Clinically, lumbar spinal stenosis is the most common, followed by cervical spinal stenosis, and thoracic spinal stenosis is the least common. Spinal stenosis caused by vertebral arch developmental disorders before or after birth in patients with congenital spinal stenosis is the most common developmental spinal stenosis limited to vertebral arch development disorders, also known as idiopathic spinal stenosis. The main cause of acquired spinal stenosis is degenerative changes in the spine. Cervical spinal stenosis is more common in middle-aged and elderly people. The most common site is the lower cervical vertebra, which is most common in the 4-6 segment of the neck. basic knowledge The proportion of illness: 0.03% Susceptible people: no specific population Mode of infection: non-infectious Complications: cervical spondylosis
Cause
Causes of cervical spinal stenosis
According to the cause, cervical spinal stenosis is divided into four categories
1. Developmental cervical spinal stenosis.
2. Degenerative cervical spinal stenosis.
3. Iatrogenic cervical spinal stenosis.
4. Other cervical lesions and trauma caused by secondary cervical spinal stenosis, such as cervical spondylosis, cervical disc herniation, posterior longitudinal ligament ossification, cervical tuberculosis, tumor and trauma caused by cervical spinal stenosis.
Prevention
Cervical spinal stenosis prevention
For light patients, the daily routine is to:
1. Pay attention to rest: often change posture and relieve neck muscle spasm.
2. Regular self-massage massage neck: massage can promote blood circulation, relieve meridians, relieve symptoms.
Complication
Cervical spinal stenosis complications Complications cervical spondylosis
Since the 1970s, developmental spinal stenosis is considered to be an important risk factor for cervical spondylotic myelopathy.
Symptom
Symptoms of cervical spinal stenosis Common symptoms Spinal cord compression Quadriplegia constipation Breathing difficulties Limb weakness Limb numbness Sensory disorder Muscle atrophy Urinary frequency
Sensory disorder
Mainly manifested as numbness of the limbs, allergies or pain, most patients have the above symptoms, and are the initial symptoms, mainly caused by the involvement of the spinal thalamus bundle and other sensory nerve fiber bundles. The limbs can be affected at the same time, or one limb can appear first. Symptoms, but most patients feel that the disorder begins with the upper limbs, especially in the arm, and the trunk symptoms have a second or lower rib dysfunction, and the chest, abdomen or pelvis area is tight, which is called "bundle feeling". In severe cases, breathing difficulties may occur.
2. Movement disorders
More often after the sensory disturbance, manifested as vertebral body bundle sign, for limb weakness, stiffness and inflexibility, most of the weakness from the lower limbs, heavy, foot landing like the feeling of stepping on the cotton, heavy standing and walking is unstable, easy to squat, need Walking on the wall or crutches, quadriplegia occurs as the symptoms gradually increase.
3. Defecation disorder
Generally appear later, early in the urinary and bladder weakness, frequent urination, urgency and constipation more common, late urinary retention, incontinence.
4. Signs
There are not many neck symptoms, cervical vertebrae movement limitation is not obvious, cervical spinous process or its adjacent muscles may have mild tenderness, trunk and limbs often have sensory disturbances, but not very regular, the trunk may not be in a plane on both sides, or there may be a section The sensation of the area is reduced, while the lower part of the waist is normal, the shallow reflection is reflected by the abdominal wall, the cremaster reflex is weakened or disappeared, the deep feeling is like the position sense, the vibration sense still exists, the anal reflex is always present, and the tendon reflex is more active or hyperactive, Hoffmann sign Unilateral or bilateral positive, this is an important sign of the spinal cord compression of the neck 6 or more. Babinski sign positive, sputum, sputum sputum positive, limb muscle atrophy, muscle weakness, increased muscle tone, muscle atrophy It appears earlier and has a wider range, especially in patients with developmental cervical spinal stenosis. Because the lesion base is multi-segment, the cervical spinal cord is often multi-segmented, but its plane generally does not exceed the spinal canal. The innervation zone of the highest segment of the stenosis.
Examine
Examination of cervical spinal stenosis
1. X-ray film inspection
Cervical vertebral stenosis is mainly characterized by a decrease in the sagittal diameter of the cervical canal. Therefore, the measurement of the sagittal diameter of the spinal canal in the standard lateral radiograph is an accurate and simple method for establishing the diagnosis. The sagittal diameter of the spinal canal is the posterior margin of the vertebral body. The shortest distance to the basal line of the spinous process, the absolute value of the sagittal diameter is less than 12mm, is a developmental cervical spinal stenosis, the absolute value is less than 10mm, is an absolute stenosis, more accurate by the ratio method, because of the spinal canal and vertebral body The median sagittal plane is in the same anatomical plane, and its magnification is the same, which can exclude the influence of magnification (Fig. 1). The normal spinal/vertebral body ratio is 1:1. When the ratio is less than 0.82:1, the spinal canal stenosis is indicated. When the ratio is less than 0.75:1, the diagnosis can be confirmed. At this time, the dorsal cortex of the inferior articular process may be adjacent to the basal line of the spinous process.
Degenerative cervical spinal stenosis is generally characterized by a decrease or disappearance of the cervical curvature, and even a curvature reversal, narrowing of the intervertebral space caused by degeneration of the intervertebral disc, limited or extensive hyperplasia of the posterior margin of the vertebral body, pedicle Thickening and cohesion, etc., if the ossification of the posterior longitudinal ligament is characterized by ossification of the posterior edge of the vertebral body, which is stratified or uneven in density, and there is often a translucent line between the vertebral body, which is due to the deep layer of the ligament. If there is no ossification, if the ligament of the ligamentum flavum is combined, the epiphyseal area will be the epiphyseal area of the intervertebral foramen, extending from the upper joint surface to the front and the lower side, or extending from the lower joint surface to the upper and lower sides. It is characterized by vertebral edge sclerosis and osteophyte formation, while the posterior lateral osteophytes can extend into the intervertebral foramen to compress the nerve roots. The degenerative changes of the facet joints are hypertrophy of the articular processes, articular surface sclerosis, marginal callus, and joint space stenosis. And joint subluxation and so on.
2. CT scan check
CT can clearly show the shape and stenosis of the cervical spinal canal, can clearly show the osseous spinal canal, but the soft spinal canal is not good, CTM (CT plus myelography) can clearly show the osseous spinal canal, dural sac and lesions The relationship between the various tissues and structures of the cervical spinal canal cross-section and the ratio between them, the developmental cervical spinal stenosis is prominent, the vertebral arch is short, and the sagittal diameter of the lamina is shortened. The diameter of the spinal canal is smaller than normal, the spinal canal is flat triangle, the dural sac and the spinal cord are crescent-shaped, the sagittal diameter of the spinal cord is smaller than normal, the median sagittal diameter of the cervical spinal canal is less than 10 mm, and the degenerative cervical spinal canal stenosis. CT showed irregular and dense osteophytes at the posterior edge of the vertebral body, and protruded into the spinal canal, hypertrophy of the ligamentum flavum, pleats or calcification, and spinal atrophy showed a narrowing of the spinal cord and a relative widening of the subarachnoid space. It can be developed during examination. The cystic cavity is located at the level of the intervertebral disc. The ossification of the posterior longitudinal ligament is characterized by the posterior margin of the vertebral body. The density is the same as that of the dense bone. The shape is different. The bone or the posterior edge of the vertebral body can be seen completely or not. Complete gap, The ossification of the ligament is bilaterally symmetrical. The obvious ossification can cause compression of the spinal cord. The thickness of the ligament is more than 5mm. It is symmetrical in the shape of a hill. The density of ossification is often slightly lower than that of the dense bone. There can be a translucent between the bone and the lamina. In the crevice, the ossification of the joint capsule of the ligamentum flavum can extend outward to cause narrowing of the intervertebral foramen.
3. MRI examination
MRI can accurately display the location and extent of cervical spinal stenosis, and can directly show the pressure of the dural sac and spinal cord in the longitudinal direction, especially when the severe subscleral cavity is completely obstructed due to severe spinal stenosis, the head and tail of the obstructive lesion can be clearly displayed. The position of the side, but MRI showed less than normal CT and pathological bone structure of the spinal canal, because the cortical bone, annulus fibrosus, ligament and dura mater were low signal or no signal, osteophytes, ligament calcification or ossification was also Low signal or no signal, therefore, it is not as good as conventional X-ray film and CT scan in showing the relationship between spinal degenerative disease and spinal cord and nerve root, mainly showing T1 weighted image showing the compression displacement of spinal cord, and can also directly display Whether the spinal cord has degeneration and cystic changes, T2-weighted images can better show the pressure of the dural sac.
4. Myelography
As a diagnosis of intraocular space occupying lesions and spinal morphological changes and their relationship with the spinal cord, early detection of intraspinal lesions, determination of lesion location, extent and size, detection of multiple lesions, qualitative diagnosis of certain diseases .
Diagnosis
Diagnosis and differentiation of cervical spinal stenosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Cervical spondylotic myelopathy: mainly due to cervical spinal disc herniation or osteophyte caused by spinal cord compression symptoms, mostly in the 40 to 60 years old, the lower extremity begins to numb, heavy, and then difficult to walk, can appear spasm, neck stiffness The neck can easily cause numbness of the limbs, hyperreflexia, Hoffmann sign, Babinski sign positive, feeling often obstacles, more irregular, shallow reflexes weaken or disappear, deep feeling exists, heavy, urinary incontinence, positive lateral position X-ray film cervical vertebrae straight or backward angulation; multiple intervertebral space stenosis; bone hyperplasia, especially vertebral body posterior margin spurs more; cervical lateral overflexion, can have cervical instability, CT And MRI can observe spinal stenosis and cervical spinal cord compression, lesion performance.
2. Ossification of the posterior longitudinal ligament of the cervical spine: slow course of disease, stiff neck, limited activity, clinical manifestations and cervical spondylosis have many similarities, only clinical symptoms and signs are difficult to diagnose, must rely on imaging examination, X-ray film 80% of patients can be diagnosed, showing a sacral or cloud-like ossification shadow on the anterior wall of the cervical canal. If necessary, a tomographic slice can be diagnosed. CT scan can confirm the diagnosis, and can observe and measure the bone shape distribution and its The relationship between the cervical spinal cord and the diagnosis of this disease MRI is not as good as CT scan from the imaging point of view.
3. Cervical spinal cord tumor: manifested as progressive compression of the spinal cord, the patient's symptoms increased, from single limb development to limbs, urinary retention, bedridden, sensory disturbances and movement disorders at the same time, X-ray film can be seen in the intervertebral The hole is enlarged, the pedicle is thinned, the distance is widened, and the vertebral body or vertebral arch is destroyed. For example, the tumor is located under the extramedullary epidural space. The myelography shows a change in cup-like morphology, and the protein content of cerebrospinal fluid is significantly increased. CT or MRI is used to identify Diagnosis is helpful.
4. Syringomyelia: It occurs in young people, the course of the disease is slow, the pain and temperature are separated from the sense of touch, especially the temperature is reduced or disappeared. The myelography is smooth, MRI can confirm the diagnosis, and the cervical spinal cord is cystic. The central tube is expanding.
5. Amyotrophic lateral sclerosis is a motor neuron disease with symptoms of upper limbs and lower limbs. It is progressive, tonic spasm, no sensory disturbance and bladder symptoms. The sagittal diameter of the spinal canal is normal and the myelography is smooth.
