Data of cervical spondylosis of accessory nerve root type
Cervical spondylotic radiculopathy
Cervical spondylotic radiculopathy is a common disease in middle-aged and elderly people, with more males than females, accounting for 56% and 7% of all kinds of cervical spondylosis respectively. Gravity work is too much, and the onset is slow, sometimes induced by a certain degree of injury; It can also induce excessive bowing and long-term bowing. It can be unilateral or bilateral. It is caused by the compression and stimulation of nerve roots by the protrusion behind the cervical vertebra. Its symptom is pain. Pain is colic, dull pain or burning pain, and neck dysfunction affects work and sleep.
Etiology and pathogenesis
Due to the special anatomical structure of the neck, the long-term bearing skull, coordination and wide-ranging activities, the heavy stress borne by the cervical spine varies during extension and flexion, as well as lateral rotation and lateral bending. If the neck posture is not good and you are tired for a long time, it is easy to cause soft tissue strain such as neck muscles and ligaments. Head and neck trauma, or wind, cold, dampness, internal injuries, degenerative diseases of cervical joints, inflammatory stimulation, etc. , leading to cervical muscle spasm, destroying the balanced stress of the cervical spine, or when the neck activity is beyond the normal range, the skull can cause the rotation and displacement of the vertebral joints under the action of a slight external force, and the cervical intervertebral disc will be affected by such external force, resulting in degenerative diseases of the cervical intervertebral disc, and even the nucleus pulposus will come out from the rear, compressing or stimulating the nerve roots, resulting in clinical symptoms. At the same time, it also accelerates the pathological changes of cervical joints, leads to changes in the anatomical position of cervical vertebrae, and causes cervical instability and metabolic hyperosteogeny. If compression or inflammatory stimulation occurs, it will cause cervical spondylotic radiculopathy. For example, hyperosteogeny of Rushka joint can cause the intervertebral foramen to narrow; Traumatic strain or bleeding caused by dislocation of cervical joint, blocking meridians, blood stasis and qi stagnation, inducing hypertrophy, adhesion and fibrosis of root sheath tissue, and nerve roots can be twisted or deformed when stimulated or compressed by flattening, which is the main cause of cervical spondylotic radiculopathy; For example, the backward proliferation of uncinate process joint spurs can stimulate and compress nerve roots; Bone hyperplasia at the posterior edge of vertebral body and compression of the anterior root in spinal canal can lead to motor nerve damage, and there is dull pain or heavy feeling in the deep muscles of neck, shoulder or upper limb dominated by the involved nerve root.
The greater occipital nerve passes through the pedicle of the central and axis, causing soft tissue injury or dislocation around the central and axis, or causing headache. Patients with upper respiratory tract virus infection often have radiation pain and numbness on one or both sides of neck, shoulder, chest and upper back, and have corresponding regional sensory and motor disorders, and deep reflex is weakened or disappeared. There may be tenderness and radiation pain near cervical vertebra and thoracic vertebra, but the onset is young and there is a history of infection, which needs X-ray differentiation. Cervical facet synovitis, joint capsule effusion and swelling can stimulate adjacent nerve roots and cause root pain.
If the anterior branch of the cervical 5 chest 1 is agitated, the patient may have upper limb brachial plexus neurosis. Sensitive nerve endings are distributed in the joint capsule during the sudden arthritis, which can reflexively cause spasm of related muscles, resulting in radiation pain on one side, swelling and pain in the neck and shoulder, and limited neck function.
Root artery is the nutrient artery of nerve, and the anterior root artery in front of nerve root in intervertebral foramen is compressed, which causes ischemic lesions of corresponding nerve root and causes root symptoms.
The injury of anterior scalene muscle or the displacement of the affected vertebra will affect the nerve roots that control this muscle and cause muscle spasm. When the anterior scalene muscle contracts, it can compress the brachial plexus nerve and subclavian artery located between the anterior and middle scalene muscles, causing radiation pain in the shoulders and upper limbs, numbness in the ulna area, and lowering the skin temperature of the upper limbs. Nerve endings distributed in muscles and tendons are easily stimulated by passive activities, thus causing painful reactions.
Clinical manifestations and diagnosis
(1) Clinical manifestations The clinical manifestations of cervical spondylotic radiculopathy are pain, mainly neck and shoulder pain, radiating to one or both upper limbs. Pain is colic, pure pain or burning pain, which affects work and sleep. The pain is aggravated when the head and neck stretch back and cough, sneeze and defecate hard. Some patients have headaches, dizziness and tinnitus. The upper limbs are heavy, sore and weak, the grip strength drops, or objects fall to the ground easily. Numbness and pain often appear in fingers and forearms.
Signs: The neck is obviously limited in movement and stiff. Tenderness often occurs in the spinous process of the diseased vertebra, the upper internal angle of the scapula and the pectoralis major area. Sensation of upper limbs and fingers decreases, and muscle atrophy may occur. The main nerve innervating biceps brachii is cervical nerve 6. The triceps brachii is the cervical nerve 3. In the early stage of the disease, if these nerve roots are stimulated, tendon reflex will be active and lateral tendon backfire will be reduced or disappeared.
(2) The diagnosis of cervical spondylotic radiculopathy is mainly based on the symptoms of nerve root, tendon reflex and pain changes in upper limbs, cervical spinous process, thumb palpation of soft tissue and X-ray findings of cervical spine, and combined with clinical symptoms, most cases can be diagnosed in time. The clinical diagnosis of cervical spondylotic radiculopathy is as follows:
1, the patients are between 40 and 60 years old, with more males than females.
2. Patients have neck, shoulder and arm pain, finger numbness and other symptoms, and some patients may be complicated with vertigo caused by cervical spondylosis of vertebral artery type.
3. The patient's neck rotation or backward extension is restricted.
4. The patient's displaced spinous process and joint capsule have obvious tenderness.
5. The lateral X-ray films of some patients can show pain and vertebral displacement; Orthographic or oblique films show hyperosteogeny at the posterior edge of vertebral body and uncinate joint, or anatomical position changes caused by pain and vertebral body displacement. Combined with clinical symptoms and signs, the significance of these X-ray changes lies in localization. Some cervical spondylosis disappeared with physiological protrusion, the intervertebral space became narrower, and there was hyperosteogeny in the adjacent vertebral bodies. There may be cervical spondylolisthesis.
6. The test showed that 1 brachial plexus traction was positive; 2. Positive neck pressing test; 3. The extrusion test of intercostal foramen was positive.
Treatment of Drug Addiction: TCM Syndrome Differentiation and Treatment
The treatment of cervical spondylotic radiculopathy mainly focuses on promoting blood circulation to remove blood stasis, relaxing muscles and tendons to relieve pain, eliminating dampness and dispelling cold, which has a certain effect on relieving the symptoms of this disease. Commonly used Chinese patent medicines include: Jingfukang, Shi Feng Bitong Tablet and Guci Tablet. Commonly used prescriptions include: Cervical Vertebral Tongbi Formula, Huoxue Zhitong Formula, Laogaishang Decoction, Huoxue Tongsui Decoction, Sanbi Decoction, etc.
My invention (Jing Yao Gukang Pill) has a radical effect on this disease. Clinical observation of taking this medicine for two to three courses shows that nearly 300 people do not relapse for eight years.
Clinical medical record playback: Cui Moumou, male, 52 years old, national cadre. From June 5, 2002 to February 3, 2002, the patient complained of pain in both upper limbs and came to the hospital for more than one month. Pain radiates to the middle finger, ring finger and little finger, and the middle finger is the most numb. MRI (film number: 132 1) reports: cervical intervertebral disc 4-6 protrudes backward, cervical spinal canal is narrow, intervertebral disc 2-7 degenerates, nerve roots are compressed, and spinal cord signal is abnormal. Deep pulse, pale tongue, thin and white fur, and red tongue tip. Traditional Chinese medicine diagnosis: wind-cold arthralgia; Western medicine diagnosis: cervical spondylotic radiculopathy. Treatment is to warm channels and dissipate heat, promote blood circulation and dispel wind and remove arthralgia. Oral jingyaogukang pills (same as above). External use of "Vertebral Foot Pain Ointment" made the patient unable to sleep for nearly 45 days due to severe pain. In addition, the usage of traditional Chinese medicine decoction is as follows: Radix Puerariae, Ramulus Cinnamomi, Radix Paeoniae Alba, Radix Paeoniae Rubra, Radix Clematidis, Lumbricus, Olibanum, Myrrha, Scorpio, Carapax et Plastrum Testudinis, and Radix Aconiti Kusnezoffii (packaged separately) are decocted for 40 minutes, and then the rest medicines are added. One dose a day, twice in the morning and evening. On June 6, 65438, I went to see a doctor for the second time. After taking the medicine, my pain was relieved and I could sleep for 3 hours every night. The effect is different from the prescription, three doses, the same as before. The third diagnosis was made on June 5438+September: mild pain in upper limbs and numbness in hands, and Astragalus and Angelica were added to the defense prescription. Fourth visit on February 26th, 65438: The upper limb still felt mild pain, so I stopped using Chinese medicine decoction and external plaster and only took Jing Yao Gukang Pill. * * * three courses of treatment, if you lose. June 5438+October 2004 10, MRI was reviewed and compared (film number: Sanmenxia Hospital of Yellow River. 1 13443). Except for slight compression of nerve roots, there is no obvious stenosis of spinal canal and no abnormality of spinal cord signal. Cervical spondylosis recurred in 2004, still working.