What tests should cervical spondylosis do?

I'm Dr. Xiaoying, an imaging doctor. I want to talk about the imaging examination of cervical spondylosis from the perspective of imaging.

What is cervical spondylosis? Cervical spondylosis, also known as cervical spondylosis in technical terms, is a general term for cervical osteoarthritis, cervical disc herniation, cervical nerve root syndrome and proliferative cervicitis, and it is a disease based on degeneration caused by various reasons.

Cervical spondylosis can be divided into cervical spondylosis, vertebral artery type cervical spondylosis, nerve root type cervical spondylosis, sympathetic cervical spondylosis, cervical spondylotic myelopathy and esophageal compression type cervical spondylosis.

The symptoms of cervical spondylosis are many and complicated. It can be manifested as shoulder and neck pain, hand weakness, numbness, dizziness, headache and even vomiting. Symptoms are related to the location and severity of the lesion.

What are the examinations about cervical spondylosis? The examination of cervical spondylosis includes clinical physical examination and auxiliary examination. When one or more of the above symptoms appear, it is best to go to the neurology department for treatment. Clinicians will ask the symptoms again, and then do a preliminary physical examination to see if there is any manifestation of cervical spondylosis. This is a physical examination.

The most important auxiliary examination is imaging examination, including anteroposterior position, biclinic position, mouth opening position and hyperextension and flexion position of cervical spine. This is also called a complete cervical vertebra, and only a part of it can be photographed, but the anterior and posterior position of the cervical vertebra must be photographed. This is the most basic examination. By looking at the shape and physiological curvature of the cervical spine, we can observe whether there is hyperosteogeny, narrowing of intervertebral space, dislocation of atlantoaxial joint and intervertebral foramen.

In addition, I want to explain that when taking cervical X-ray, I can't see the cervical intervertebral disc, so I can't see whether the intervertebral disc is protruding. X-ray can only see the basic morphology and hyperplasia of cervical spine.

The second is cervical intervertebral disc CT, which can show whether there is hyperosteogeny and disc herniation, but the observation of spinal cord compression is not as good as magnetic resonance.

This is a CT film of a 33-year-old patient. He is coming to make a CT disk today. He is suspected of cervical spondylosis. After CT, many disc herniation were found, one of which was very serious. Severe disc herniation compresses the spinal cord, and high paraplegia may occur.

The third kind is magnetic resonance, which is more expensive than the first two kinds, but it can observe whether the cervical intervertebral disc is protruding, and the observation of nerve roots and spinal cord is the clearest, but the observation of cervical spine is not as good as the first two kinds.

Therefore, the three examinations have their own advantages for cervical spondylosis. Sometimes if you suspect cervical spondylosis, you have to do one, two, maybe three, and the clinician will judge according to the condition.

Another point is that many friends with cervical spondylosis go to the doctor because of dizziness and headache. First of all, they have to rule out the brain lesions, that is, the most dangerous situation in the brain, before considering the possibility of cervical spondylosis, so many people have to do head CT examination.

How to prevent cervical spondylosis? 1. Avoid sedentary and sedentary occupations. You can get up and walk around at the right time. I am also a sedentary career. Sometimes I'm very busy. I sit all morning.

2. Avoid playing mobile phone for a long time. This is a bit difficult. Nowadays, there are more and more low-headed people, and people who play mobile phones can be seen anytime and anywhere.

Don't let the air conditioner blow directly on the head and neck in summer.

4. Choose the right pillow and relax your neck when you sleep.

5. You can do the health exercise of the lower cervical vertebra in the morning or in your spare time, and slowly bend, stretch, bend left and right, and rotate your neck.

Cervical spondylosis is a common degenerative disease, the main clinical manifestations are symptoms of vascular compression such as neck discomfort and dizziness, symptoms of spinal cord and nerve such as numbness of upper limb endings and gait changes, or symptoms of joint instability such as abnormal neck movement. Cervical spondylosis can be divided into cervical spondylosis, nerve root cervical spondylosis, cervical spondylotic myelopathy, vertebral artery cervical spondylosis and mixed cervical spondylosis.

Cervical spondylosis is mainly limited signs such as neck up and down, including pain and discomfort in occipital and scapular, and muscle stiffness, so it is also called local cervical spondylosis. So the tests to be done are: 1, routine physical examination (neck tenderness, extensive muscle tension and stiffness). 2. plain film on the front of the neck. 3. According to the severity of symptoms, neck CT can also be added.

Cervical spondylotic radiculopathy, as its name implies, is a kind of cervical spondylosis with nervous system symptoms as the main symptoms, mainly including root pain, that is, limb pain, numbness, muscle weakness and abnormal tendon reflex, which is consistent with the distribution of spinal nerves in the stage of cervical involvement. The necessary examinations are: 1, routine physical examination, and pay attention to the corresponding segments of pain, numbness and abnormal muscle strength. 2. Cervical compression test and spinal nerve traction test (generally positive). 3. neck x-ray and CT.

Cervical spondylotic myelopathy often has a history of trauma or stiff neck. Due to the pathological changes of the spinal cord, the symptoms gradually developed from numbness and heaviness of limbs to difficulty in walking, and the feet felt like cotton. Severe cases can cause difficulty in defecation, accompanied by abnormal skin sensation of limbs, sensory disturbance of trunk, abnormal muscle strength of limbs, muscle spasm and hyperreflexia. This kind of physical examination needs special details: 1, detailed physical examination, pay attention to distinguish the range of numbness and pain in limbs, the left and right gap of abnormal skin sensation, and whether there is spasm or hyperactivity. 2. Lateral X-ray film of cervical vertebra. 3, cervical CT (clear the size and direction of compression). 4. Cervical MRI (to confirm the diseased segments of the spinal cord).

Vertebral artery type cervical spondylosis, due to the compression of vertebral artery and related nerves, leads to dizziness, headache, cataplexy, decreased vision and sensory disturbance. Required physical examination: 1, routine physical examination. 2. The neck rotation test was positive. 3, cervical X-ray. 4. Vertebral artery MRA (magnetic resonance angiography) or subtraction vertebral artery angiography (DSA), MRA can indicate the degree of vertebral artery distortion and stenosis, which is of great significance for diagnosis.

The condition of mixed cervical spondylosis is more complicated, and the symptoms are often the combination of several types of cervical spondylosis, which requires various examination and diagnosis.

To sum up, cervical spondylosis needs to be examined according to symptoms and conditions, and the specific classification should be clear.

Answer in this issue: master of medicine in Xiangyi.

First of all, we must clarify the concept of cervical spondylosis. Cervical spondylosis refers to the degeneration of cervical intervertebral disc tissue and its secondary lesions, involving surrounding tissues (including spinal cord, nerve roots, vertebral artery and sympathetic nerve), leading to corresponding clinical manifestations.

The development of cervical spondylosis is generally divided into three stages: the first stage of intervertebral disc degeneration, the second stage of spur formation, and the third stage of damage.

To diagnose cervical spondylosis, we need to find out two questions, whether it is cervical spondylosis or not, and what kind of cervical spondylosis it is.

First, is it cervical spondylosis. First, it has the clinical manifestations of cervical spondylosis (including neck pain with arm numbness, lower limb weakness, headache, dizziness, tinnitus, blurred vision, fatigue, cataplexy and so on). Secondly, imaging examination shows degeneration, degeneration and hyperplasia of intervertebral disc, vertebral body and intervertebral joint, and the clinical symptoms should correspond to the imaging examination results. It should be noted that if only the imaging examination is abnormal and the clinic is asymptomatic, it can not be diagnosed as cervical spondylosis.

Diagnostic criteria of radiological examination: the physiological curvature of cervical spine disappears or the angulation is reversed; Vertebral deformation; Lumbar space stenosis and vertebral degeneration; Intervertebral joint looseness; The sagittal diameter of spinal canal was1012mm, and the Pavlov ratio was 0.75.

CT scan: The transverse section of cervical vertebra showed degeneration, protrusion and osteophyte formation of intervertebral disc.

Magnetic resonance imaging: judging from different signal displays of spinal canal, spinal cord and intervertebral disc.

Second, what kind of cervical spondylosis. Clinically, it can be divided into cervical local type, nerve root type, spinal cord type, vertebral artery type, sympathetic nerve type, anterior central spinal artery compression type and other types according to the different involved sites. Specifically, it should be judged by combining clinical manifestations and examination results.

Thank you. I hope my answer is helpful to you.

These tests can roughly distinguish the state of some diseases, but more detection means and methods are needed.

The first is to distinguish it from other types of diseases.

For example, in many cases, head diseases can also cause related symptoms, so it is necessary to carry out head CT, head magnetic resonance imaging and other related examinations. Sometimes even tumors in the thoracic spine have similar symptoms, and chest CT and other related examinations are needed.

Secondly, it is necessary to make clear the neurophysiological activities of limbs, especially those with hemiplegia and numbness, and to check the electromyography of both upper limbs or lower limbs.

In addition, for the further analysis of cervical spondylosis, it is necessary to detect the plain film of cervical spondylosis in the open mouth position or the hyperextension and flexion cervical spondylosis to distinguish some rare disease forms and clarify the later surgical plan.

Finally, if cervical spondylosis needs surgical treatment, it is necessary to carry out chest CT, electrocardiogram, blood routine, coagulation, biochemical infectious disease screening and other related detection means and methods to ensure the most basic life safety of patients and no obvious surgical contraindications.

Generally speaking, although cervical spondylosis is relatively common and universal, it must be judged according to the actual situation. Different patients have different clinical manifestations, and different manifestations have different treatment methods, which need attention.

I wish you all good health!

The examination of cervical spondylosis includes physical examination and auxiliary examination. Check with a doctor to see if there are any symptoms of cervical spondylosis, including local tenderness points, range of motion of cervical spine and some cervical spine examinations. In addition, in order to locate diagnosis or differential diagnosis, nervous system examinations such as sensation, movement and reflex are sometimes appropriately selected. For example, the distribution area of sensory disturbance in hands and upper limbs is directly related to the location of cervical involvement. Exercise examination is mainly about muscle tension, muscle strength, gait and so on.

Auxiliary examinations include X-ray examination, magnetic resonance imaging, CT, myelography and vertebral artery angiography. In addition, in order to differentiate diagnosis, cerebrospinal fluid examination, electromyography, cerebral rheogram and other examinations can be carried out as needed.

Routine auxiliary examination, mainly X-ray examination, can take plain films of cervical vertebrae in the positive position, lateral position and oblique position. (1) Orthoposition: Observe whether there are congenital abnormalities such as dislocation of pivot joint, fracture or odontoid process loss; Whether the transverse process of the seventh cervical vertebra is too long and whether there are neck ribs; Whether uncinate joint and intervertebral space are widened or narrowed. (2) Lateral position: Observe the changes of cervical curvature, osteophyte, narrowing of intervertebral space, subluxation, narrowing of intervertebral foramen and calcification of nuchal ligament. (3) Oblique position: Observe the size of intervertebral foramen and the hyperosteogeny of uncinate joint.

About 90% of normal men over 40 years old and normal women over 45 years old have cervical spine spurs. Bone spur may be the manifestation of cervical instability and aging, so the changes of X-ray plain film such as cervical straightening and bone spur are not necessarily accompanied by clinical symptoms, so it can not be easily diagnosed as cervical spondylosis.

CT has been used to diagnose spinal canal enlargement or bone destruction caused by ossification of posterior longitudinal ligament, spinal canal stenosis and spinal cord tumor, and to estimate the degree of osteoporosis by measuring bone density. In addition, because the cross-sectional images can clearly see the soft tissue and subarachnoid space inside and outside the epidural sheath, it can correctly diagnose disc herniation, neurofibroma, syringomyelia of the spinal cord or medulla oblongata, and has certain value for the diagnosis and differential diagnosis of cervical spondylosis. MRI has a good effect in displaying the occupying and compression of spinal canal, displaying spinal cord signals and judging prognosis.

The diagnosis of cervical spondylosis can only be made under the guidance of professional doctors, according to clinical symptoms and signs, combined with imaging examination, and at the same time excluding related diseases. Sometimes, atypical symptoms are easily missed and misdiagnosed. Never make a subjective diagnosis, so as not to delay treatment.

In recent years, cervical spondylosis, a chronic disease, has become more and more common in life. As far as the current level of medical technology is concerned, cervical spondylosis cannot be cured. So for patients with cervical spondylosis, in order to better control the development of the disease, what tests should be carried out at this time?

At present, patients with cervical spondylosis need physical examination and auxiliary examination. Under normal circumstances, the physical examination should be examined by a doctor before the symptoms of cervical spondylosis can be finally determined. Common examinations include whether there are tender points in the body, the range of motion of the patient's cervical spine and some necessary cervical spine examinations.

In addition, in order to make a better localized diagnosis or differential diagnosis, we should also check the nervous system such as sensation, movement and reflex in combination with the actual situation of the patient's body and make appropriate choices. The so-called exercise examination mainly refers to the examination of muscle tension, muscle strength and gait of patients.

Auxiliary examination is mainly imaging examination, including X-ray examination, magnetic resonance imaging, CT examination and other items. In addition, in order to better identify and diagnose patients' diseases, cerebrospinal fluid examination, electromyography and rheoencephalogram can be performed according to patients' actual needs. Take the most common X-ray examination as an example. At this time, the patient's cervical vertebra can be photographed in the frontal, lateral and oblique plain films.

Why do you want to look in different directions? They have different purposes. The frontal section is mainly to observe whether the patient has congenital abnormalities such as atlantoaxial dislocation, odontoid fracture or deletion. In addition, observe whether the transverse process of the seventh cervical vertebra is too long, whether the cervical rib, uncinate joint and intervertebral space are widened or narrowed. The cross section is to observe the changes of cervical curvature, the narrowing of intervertebral space and the calcification of nuchal ligament. With the help of oblique section, the size of intervertebral foramen and the hyperosteogeny of uncinate joint can be better observed.

It should be noted that in the diagnosis of cervical spondylosis, patients should choose a regular hospital at this time, and as far as possible, under the guidance of professional doctors, combined with the clinical symptoms and signs of patients, choose appropriate examination items as appropriate. Patients should not make subjective and arbitrary diagnosis at this time, so as not to delay the clinical treatment of their own diseases.

The code word is not easy, please like it and click "+attention" in the upper right corner to update the orthopedic science knowledge every day. If you have any questions or different opinions, please leave a message in the comment area. Cervical spondylosis is a clinical syndrome caused by the stimulation or oppression of blood vessels, nerve roots and spinal cord caused by cervical degeneration. Clinical examination should be based on the type of symptoms. It is best to take X-ray films (positive, lateral and hyperextension and flexion) mainly with dizziness and headache, and take double oblique films mainly with neck, shoulder and upper limb pain. If the lower limbs are weak, do MRI directly.

The main auxiliary examination of cervical spondylosis: 1. X-ray examination is mainly to make a rough judgment of cervical spondylosis, aiming at the bony structure to see if there is dislocation. Do you have a reverse bow? Is there any rotational displacement of the vertebral body? What is hyperosteogeny? Is there any loss of intervertebral disc height? Is there any stenosis of intervertebral foramen? We can make a preliminary judgment on the middle and advanced tumors and tuberculosis. 2.CT examination clearly shows the early and middle stage tumor and tuberculosis, and measures dislocation, hyperosteogeny and intervertebral disc degeneration at the same time, and the data reliability is higher than that of X-ray. The compression of intervertebral disc herniation on nerve or spinal cord can be clearly displayed, and the degree of protrusion can be measured, and whether calcification is judged according to CT value is superior to magnetic resonance (MRl). 3.MRl can clearly display cervical fascia, blood vessels, nerves and intervertebral discs, especially the inflammatory lesions of the above structures, and can clearly display tumors, tuberculosis and metastatic lesions with high data reliability. 4. In recent years, the application of far-infrared thermal imaging technology in pain department can provide objective judgment for neck and shoulder fascia injury and provide reference for functional lesions.

The physical examination of cervical spondylosis mainly depends on the touch of specialists, which can check the dislocation, anti-bow, rotation, tension and pressure of local tissue structure, and can be corrected by hand. In recent years, pain rehabilitation experts have adopted rehabilitation evaluation technology and stretching therapy evaluation technology, aiming at the limitation of cervical soft tissue injury on cervical functional activities, they can easily and quickly lock a certain group of muscles, and get miraculous effects every time through targeted treatment! Physical examination is a useful supplement to instrument examination, but it can never replace instrument examination.

In short, physical examination and auxiliary examination have their own emphasis and complement each other. Good application, complement each other. Physical examination, used well, can save the cost and time of large-scale equipment CT and magnetic resonance examination. Auxiliary examination can determine whether there is tumor or tuberculosis and locate disc herniation, which is beyond the physical examination.

Xiao Wang, a 32-year-old programmer, works at least 8 hours in front of the computer every day. In the first few years after graduation, he didn't feel any discomfort. Recently, I feel that the skin on my neck is particularly dull, and my fingers on my left hand occasionally feel numb. When I went to the hospital for a check-up, I found that the cervical vertebra was straight, the intervertebral disc was protruding, and the left nerve root was stimulated by compression.

In the past, cervical spondylosis was a senile disease, mainly caused by cervical degeneration; The proliferation of uncinate joint and intervertebral foramen compresses blood vessels, and the compression of prominent intervertebral disc stimulates nerve roots, causing a series of symptoms.

But now many young people have cervical spondylosis and cancer is younger. Why is cervical spondylosis younger? Most of them are caused by mobile phones, computers and tablets. Long-term bow is very harmful to cervical spine.

What are the manifestations of cervical spondylosis? Symptoms of cervical spondylosis are closely related to the classification of cervical spondylosis;

1, nerve root type (the most common type): headache and numbness in neck, shoulders and upper limbs, burning sensation and needle-like pain in upper limbs when riding a bicycle.

2. Spinal cord type (the most serious type): limping or paralysis of lower limbs, weakness of upper limbs, muscle atrophy in some patients.

3. Vertebral artery type: Most patients have dizziness, headache and memory loss; In severe cases, nausea, vomiting and cerebral infarction may occur.

4, sympathetic nerve type: irritability, dry mouth, insomnia, dreaminess, headache, arrhythmia, unstable blood pressure.

Suspect cervical spondylosis, what examination should I do? If you want to know what to do, you must first understand what you want to know.

Patients with cervical spondylosis need to observe the curvature of cervical spine, whether the intervertebral space is narrow, and the hyperosteogeny of vertebral body, uncinate process joint and intervertebral foramen; It is necessary to know the disc herniation, nerve root compression, spinal canal stenosis and spinal cord compression degeneration and necrosis.

X-ray of cervical spine is mainly to understand the bone results, and the stability can also be understood by overstretching and flexion of cervical spine. CT also observes these contents, but its radiation is several hundred times that of plain film, so plain film of cervical vertebra can be the first choice when looking at the bone condition of cervical vertebra.

The above cervical plain film and CT can't reflect the situation of the spinal cord in the spinal canal, but magnetic resonance can make up for this defect, and can clearly show the shape of the spinal cord, whether there are abnormal signals or not, and the nerve roots can also be clearly displayed.

Therefore, for patients with suspected cervical spondylosis, it is generally recommended to do cervical plain film and cervical magnetic resonance instead of cervical CT.

Respiratory Guardian-Cervical Spondylosis (10)