walking on cotton
Introduction
Introduction Symptoms of cervical spondylosis may result in weakness of the lower limbs, unstable walking, numbness of the feet, and feeling of walking cotton when walking. Cervical spondylosis, also known as cervical vertebra syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. It is a disease based on degenerative pathological changes. Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening; nucleus protruding or prolapse; spur formation; ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.
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.
Examine
an examination
Related inspection
Spinal MRI examination of the nervous system
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 only a small type, mainly one type, one to several types mixed together, called mixed cervical spondylosis.
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 tightness, 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.
Lumbar spondylosis such as cervical spondylosis and lumbar disc herniation and lumbar spinal stenosis are both degenerative changes of the spine, both of which are prone to neuralgia. However, there are more obvious differences between the two. In general, cervical spondylosis is more complicated and variable than the symptoms and signs of lumbar spondylosis, and it is more likely to be ignored by patients and missed diagnosis and misdiagnosis by doctors. Symptoms and signs caused by cervical spondylosis are more extensive and severe than lumbar spondylosis.
Diagnosis
Differential diagnosis
1. A condition that must be differentiated from the upper cervical disc syndrome:
Sprain or subluxation of the occipital and ankle joints can often cause the same clinical manifestations as the upper cervical disc syndrome. The patient is younger, with or without a history of injury, often complaining of severe neck pain, radiating to one side of the scalp, to the forehead. The neck is stiff, the paravertebral muscles are paralyzed, and the neck cannot be turned. It is often deformed by the torticollis. There is tenderness at the paravertebral muscles and "wind pool", but no upper limb pain and signs. X-ray film is normal, or the subluxation of the atlantoaxial joint is seen from the mouth of the mouth. These signs are common in "pillows" and in children are spontaneous subluxations of the cervical spine. The so-called "slipping pillow" is a paraspinal tendon caused by a subluxation or a joint sprain in the upper neck due to poor sleep posture. However, after middle age, especially for the accumulative "slowing pillow", the upper cervical disc degeneration should be suspected.
2. Conditions that must be differentiated from root cervical spondylosis:
Because root cervical spondylosis is more common in the lower cervical segment, it is manifested as brachial plexus neuralgia, so it must be differentiated from the thoracic outlet, shoulder, elbow, and radiculitis.
(1) Anterior scalene syndrome or "thoracic outlet syndrome": The distal nerve roots of the brachial plexus, especially the T1 nerve root, can be squeezed at the thoracic outlet at the anterior scalene and middle scalene muscles. Between the first rib. If a neck rib or fiber band is emitted from the cervical vertebra, the chest; the nerve root and subclavian artery will be lifted and oppressed. The patient has pain and loss of the inner side of the forearm (neck 8 or chest 1 skin area), the hand is cold, white or purple, and the brachial artery beats weakened or disappeared. The neck can be seen from the X-ray positive slice, the transverse process is longer, or there is a neck rib.
(2) supraclavicular mass or Pancoast tumor: rare, mostly originated from the supraclavicular fossa lung tip lung cancer. The upper limb of the patient has a root disease, and the sensory abnormality or disappearance of the cervical 5 and 6 nerve distribution areas. Neck 8, chest 1 is sometimes involved, causing atrophy of the internal muscles of the hand and Horner syndrome. An opaque area is visible from the X-ray film to the tip of the lung. And the destruction of the thoracic vertebra 2.
(3) shoulder pain and shoulder disease: the lower cervical disc syndrome often has shoulder pain, shoulder muscle spasm, shoulder abduction activity and other signs, so it must be differentiated from shoulder disease, such as acromioclavicular arthritis, Acromion sac bursitis, frozen shoulder, and supinary muscle tear. However, there are no neck pain and positive X-ray signs in the shoulder disease. If it is still difficult to identify, it can be used as a cervical sympathetic ganglion block. If the "coagulation shoulder" is caused by cervical spondylosis, the nerve block is lagging behind and the shoulder can move freely.
(4) radiculitis: In viral radiculitis, the distribution of pain along the nerve roots, the muscles rapidly shrink after the onset, and there is severe tenderness along the muscles and nerves. The other case is neuropathic muscular atrophy (Spillian disease), which is severely painful and weak, but gradually recovers within a few months. Careful examination is often a specific nerve involvement, especially the nerves that innervate the anterior serratus.
(5) angina pectoris: cervical spondylosis has left upper limb ulnar pain and pain in the pectoralis major muscle area, often can be set as angina pectoris, but after injection of procaine in the pressure zone, the pain disappears. There is no tender point in the thoracic angina, and the electrocardiogram changes. Taking nitroglycerin can relieve pain.
(6) rheumatism: often have neck and shoulder pain, limited neck activity and other symptoms, but multiple, no radiation pain, the application of adrenocortical hormone has obvious curative effect.
3. Conditions that must be differentiated from cervical spondylotic myelopathy:
There are many diseases that need to be identified, and some can be identified from X-ray films, such as congenital malformations of the cervical or occipital bone, cervical fracture and dislocation, spontaneous atlantoaxial subluxation, cervical tuberculosis or tumor; some can be worn from the waist The smoothness of the subarachnoid space was identified, such as primary lateral sclerosis and atrophic lateral sclerosis without subarachnoid obstruction. Need to be identified;
(1) Spinal cord tumor: may have neck, shoulder, occipital, arm, hand pain or sensory disturbance, the ipsilateral upper limb is the lower motor neuron damage, and the lower limb is the upper motor neuron damage. Identification points: 1 From the X-ray film, the intervertebral foramen can be seen to increase, and the vertebral body or vertebral arch is damaged. 2 myelography showed that the obstruction was inverted cup.
(2) Tumors in the large occipital region: Identification points: 1 The obstruction of myelography is high, and the contrast agent cannot enter the cranial cavity. 2 late stage may have elevated brain pressure, symptoms such as fundus edema.
(3) Adhesive spinal arachnoiditis: may have spinal nerve anterior root, posterior root or spinal cord conduction bundle symptoms. Identification points: 1 There may be complete or incomplete obstruction in the lumbar puncture examination. 2 In myelography, the contrast agent is difficult to pass through the subarachnoid space and is waxy and tear-like.
(4) syringomyelia: identification points: 1 occurs in young people, 20 to 30 years old. The neck and thoracic segments are more common. 2 There are obvious, typical pain sensations and other deep and light sensation separations, and the temperature sensation diminishes or disappears, especially prominent. Spinal cord lesions can be clearly seen with 3CT and MRI.
4. Conditions that must be differentiated from vertebral artery type cervical spondylosis:
In all types of cervical spondylosis, vertebral artery type is quite common, and its incidence is second only to root type. The first, second and third segments of one or both vertebral arteries can be distorted, compressed, and affected by the cervical sympathetic nerves, causing paralysis, causing different degrees of vertebral artery insufficiency, and the tissue supplied by the vertebral artery is removed. The whole brain outside the second lobes of the forehead, as well as the central nervous system such as the cerebellum, diencephalon, brainstem, and spinal cord, are supplied to the inner ear and the eye. Therefore, its symptoms and signs are ever-changing and cannot be generalized. There are many diseases that need to be identified. This section is just a few simple symptoms.
(1) Inner ear disease: It can be internal arterial embolism, sudden tinnitus, deafness, dizziness, severe symptoms without reduction. It can also be Meniere's syndrome, with headache, dizziness, nausea, vomiting, tinnitus, deafness, nystagmus, slow pulse rate, and decreased blood pressure. Identification points: often related to factors such as excessive fatigue, rather than induced by neck activity.
(2) Eye-induced vertigo: caused by refractive errors. Identification points: vertigo disappeared when closing eyes, ametropia, eye-induced nystagmus and so on.
(3) Atherosclerosis: Identification points: 1 history of hypertension. 2 vertebral artery angiography.
(4) Retrosternal goiter: The first segment of the vertebral artery is compressed. Identification point: vertebral artery angiography.
(5) Others: such as anaemia or neurosis caused by anemia or prolonged bed rest.
