I'm Dr. Little Shadow, an imaging physician, and I'm going to talk about what imaging tests are done for cervical spondylosis from an imaging perspective.
What is cervical spondylosis?Cervical spondylosis, also known as cervical spine syndrome, is due to cervical osteoarthritis, cervical disc prolapse, cervical nerve root syndrome, proliferative cervical spondylitis, is a variety of causes of degenerative pathological changes based on the disease.
Cervical spondylosis can be categorized into cervical cervical spondylosis, vertebral artery cervical spondylosis, neurogenic cervical spondylosis, sympathetic cervical spondylosis, spinal cord cervical spondylosis, and esophageal compression cervical spondylosis.
The symptoms of cervical spondylosis are many and complex. It can manifest as shoulder and neck pain, weakness of the hands, numbness of the hands, dizziness, headache and even vomiting. The symptoms are related to the location and severity of the lesion.
What are the tests for cervical spondylosis?The examination of cervical spondylosis includes clinical physical examination and auxiliary examination. When one or more of these symptoms occur, it is best to consult a neurologist. The clinician will ask again about the symptoms and then do a preliminary examination to see if there are any signs of whiplash, which is the physical examination.
The most auxiliary examination is the imaging examination, including cervical vertebrae ortholateral, double oblique, open mouth position and hyperextension and hyperflexion, which is also called cervical vertebrae complete set, you can only shoot some of them, but the cervical vertebrae ortholateral position is a must, which is the most basic examination of the cervical vertebrae, which can be observed to see the morphology of the cervical vertebrae, physiological curvature, the presence or absence of osteophytes, whether there is any narrowing of the spinal interspace, the atlantoaxial joints are dislocated or not, and intervertebral foramen condition.
In addition, the X-ray of the cervical spine can not see the cervical discs, so the discs can not be seen whether there is no herniation. X-ray can only see the basic shape of the cervical spine, hyperplasia.
The second on the cervical disc CT, you can see whether there is bone proliferation, disc herniation, but for the spinal cord compression, the observation is not as good as the magnetic *** vibration.
This is a CT film of a patient who came to do CT disc today, 33 years old, suspected cervical spondylosis, did a CT and found multiple disc herniation, and one herniation is very serious. Severe herniated discs that compress the spinal cord have the potential for paraplegia.
The third is magnetic **** vibration, cervical disc magnetic **** vibration scanning, more expensive than the first two, but can observe the cervical disc with or without herniation, the nerve roots and spinal cord is the most clear observation, but for the cervical spine bone observation is not as good as the first two.
So each of the three tests has its own advantages for cervical spondylosis. Sometimes the suspicion of cervical spondylosis requires one, two, or possibly all three, and it is up to the clinician to make a judgment based on the condition.
Another point is that many people with whiplash have dizziness and headaches, and the first thing to do is to rule out cranial lesions, that is, the most dangerous situation in the brain, before considering whiplash, so many people have to do a cranial CT examination.
How to prevent cervical spondylosis?1. Avoid sedentary, sedentary occupations for a long time, you can get up and walk around at the right time, I also belong to sedentary occupations, sometimes busy, a sitting on the morning.
2. Avoid prolonged low head to play the phone, this is a little difficult, now more and more low head, no matter when and where you can see someone low head to play the phone.
3. Let the air conditioning blow directly on the head and neck in summer.
4. Choose the right pillow and sleep with your neck in a relaxed state.
5. Wake up in the morning or spare time to do the cervical spine health care exercise, slow flexion, extension, left and right lateral flexion and rotation of the neck movement.
Cervical spondylosis is a common degenerative disease, the main clinical manifestations of cervical discomfort, dizziness and other vascular compression symptoms, numbness of the upper extremities, gait changes in the spinal cord, neurological symptoms, or neck activities, such as the joints of the symptoms of instability. Cervical spondylosis can be categorized into cervical cervical spondylosis, nerve root cervical spondylosis, spinal cord cervical spondylosis, vertebral artery cervical spondylosis and mixed cervical spondylosis.
Cervical cervical spondylosis is mainly characterized by pain and discomfort in the upper and lower neck, including the occiput and scapula, muscle stiffness and other signs of limitation, so it is also called localized cervical spondylosis. The stage of cervical spine involvement divides the spinal nerve distribution area. The tests that need to be done are: 1) routine examination, paying attention to the segments corresponding to pain, numbness, and abnormal muscle strength. 2) neck compression test, spinal nerve pulling test (usually with a positive result). 3) cervical X-rays and CT.
Spinal cord cervical spondylosis, the onset of which is often accompanied by a history of trauma or a history of falling sleep. Due to the lesion of spinal cord, the symptom of numbness and dullness of the limbs gradually develops into difficulty in walking, cotton feeling of the feet, which may cause difficulty in urination and defecation, accompanied by sensory abnormalities of the skin of the limbs, perceptual disorders of the trunk, and abnormal muscle strength of the limbs, muscular spasm, hyperreflexia, etc. The examination of this type needs to be especially careful and meticulous. The examination of this type needs to be particularly detailed: 1. Detailed examination, pay attention to identify the scope of limb numbness, pain, skin sensory abnormalities of the left and right gap, whether spasticity, hyperreflexia. 2. lateral cervical spine X-ray. 3. cervical spine CT (to clarify the size and direction of the compression). 4. cervical spine MRI (to confirm the spinal cord affected by the lesion of the segments).
Vertebral artery cervical spondylosis, due to the vertebral artery, the related nerve compression, resulting in dizziness, headache, sudden collapse, vision loss, sensory impairment-based symptoms. Required examination: 1, routine physical examination. 2, positive cervical rotation test. 3, cervical spine X-ray. 4, vertebral artery MRA (magnetic *** vibration angiography) or subtraction vertebral artery angiography (DSA), MRA can indicate the degree of vertebral artery distortion and stenosis, which is of great significance to the diagnosis.
Mixed cervical spondylosis is a more complex condition, and the symptoms are often a combination of several types of cervical spondylosis, requiring multiple tests and diagnoses.
In summary, cervical spondylosis needs to be diagnosed according to the symptoms and the condition, and the specific type of cervical spondylosis needs to be identified and examined accordingly.
Answer: Xiang Yi, M.D.
First of all, we need to clarify the concept of cervical spondylosis. Cervical spondylosis refers to the degeneration of the cervical intervertebral disc tissue and its secondary pathological changes, involving the surrounding tissues (including the spinal cord, nerve roots, vertebral arteries, and sympathetic nerves), resulting in the corresponding clinical manifestations.
The development of cervical spondylosis is generally divided into three periods: the first period of disc degeneration, the second period of bone spur formation, and the third period of damage.
To diagnose cervical spondylosis, we need to clarify two issues, whether it is cervical spondylosis, what type of cervical spondylosis.
First, is it cervical spondylosis. The first is to have the clinical manifestations of cervical spondylosis (including neck pain with arm numbness, lower limb weakness, headache, dizziness, tinnitus, blurred vision, fatigue, sudden collapse, etc.), and the second is that the imaging examination shows degeneration, degeneration, and hyperplasia of the intervertebral discs, vertebral bodies, and intervertebral joints, and that the clinical symptoms should correspond to the results of the imaging examination. It is important to note that cervical spondylosis cannot be diagnosed if there are only abnormalities on imaging but no clinical symptoms.
Radiologic diagnostic criteria: loss of physiologic curvature of the cervical spine or reverse angulation; deformation of the vertebral body; narrowing of the intervertebral space, degenerative changes of the vertebral body; intervertebral joints loosening; the sagittal diameter of the spinal canal is 10 12 mm, and the Pavlov's ratio is 0.75.
CT scan: cervical spine cross-sectional section shows intervertebral disk degeneration, protrusion, and osteophyte formation.
MRI imaging: judgment from the composition of the cervical spinal canal, spinal cord, disc different signal display.
Second, what type of cervical spondylosis. Clinical according to the different parts of the affected area is divided into cervical localized type, nerve root type, spinal cord type, vertebral artery type, sympathetic type, spinal cord anterior central artery compression type and other types. The specifics should be combined with the clinical manifestations and the results of the examination to determine.
Thank you all, I hope my answer is helpful.
Let these tests be able to generally distinguish some disease states, but some more tests and methods are needed.
The first thing is to identify them from each other and from some other types of diseases.
For example, in many cases, head diseases may also cause related symptoms, so head CT, head MRI and other related tests. Even tumors of the thoracic spine may cause similar symptoms and require CT of the chest.
Secondly, the neurophysiological activity of the limbs should be clarified, especially for patients with hemiplegia, numbness and weakness of the limbs, but also to carry out the electromyography of the upper limbs or lower limbs.
There is also a further analysis of cervical spondylosis, which requires open-mouth cervical radiographs or hyperextension/hyperextension cervical spondylosis testing, which can differentiate between some of the rarer forms of the disease, as well as defining the later surgical options.
Finally, if cervical spondylosis requires surgical intervention, CT of the chest, electrocardiogram, blood tests, blood coagulation, biochemical screening for infectious diseases, and other relevant tests are performed to ensure that the patient's life is safe and that there are no obvious contraindications to surgery.
Overall, although cervical spondylosis is relatively common and common, but it must be judged in the context of the actual, different patients have different clinical manifestations, and different manifestations of different means of treatment, which need to pay attention to.
I wish you all the best!
The examination of cervical spondylosis includes physical examination and auxiliary examination. Physical examination should be examined by the doctor to clarify the symptoms of cervical spondylosis, including whether there are local pressure points, cervical spine range of motion and some cervical spine test examination. In addition, in order to localize the diagnosis or differential diagnosis, sensory, motor, reflexes and other neurological aspects of the examination, sometimes discretionary selection. For example, the distribution area of sensory disorders in the hands and upper limbs is directly related to the localization of the affected cervical vertebral segments. Motor examination, mainly for muscle tone, muscle strength, gait and other aspects of the examination.
Ancillary tests are X-ray examination, magnetic **** vibration imaging, CT, and also myelography, vertebral arteriography and so on. In addition, for differential diagnosis, cerebrospinal fluid tests, electromyography, and cerebral blood flow mapping may be performed as needed.
Routine auxiliary examination, mainly for X-ray examination, can take cervical spine orthopantomatic, lateral, oblique flat film. (1) Orthostatic: Observe whether there are congenital abnormalities such as dislocation of the pivot joints, fracture or absence of the odontoid process; whether the transverse process of the seventh cervical vertebrae is too long, and whether there are cervical ribs; and whether there is any widening or narrowing of the hook vertebral joints and the vertebral interspace. (2) Lateral position: Observe the change of cervical curvature, bony redundancy, narrowing of the intervertebral space, subluxation and intervertebral foramen, calcification of the collateral ligament. (3) Oblique position: observe the size of the intervertebral foramen and the osteophytes of the hook vertebral joint.
Normal bone spurs in the cervical vertebrae are present in about 90% of men over 40 years of age and about 90% of women over 45 years of age. Bone spurs can be a sign of instability and aging of the cervical spine, so radiographic changes such as straightening of the cervical spine and the presence of bone spurs are not necessarily accompanied by clinical symptoms and cannot be easily diagnosed as cervical spondylosis.
CT has been used to diagnose enlargement of the spinal canal or bone destruction due to ossification of the posterior longitudinal ligament, spinal stenosis, and spinal cord tumors, and to measure bone mineral density to estimate the degree of osteoporosis.
The diagnosis of cervical spondylosis must be made under the guidance of a professional physician, based on clinical symptoms and signs, combined with imaging, and at the same time, exclude related diseases, before the diagnosis can be made, and sometimes atypical symptoms are easy to miss and misdiagnosis. The first thing you need to do is to make sure that you have a good understanding of what is going on in your life and how it is going to be.
In recent years, cervical spondylosis, a chronic disease, has become increasingly common in life, and the current level of medical technology, it is not possible to cure cervical spondylosis disease. So for people with cervical spondylosis, in order to better control the development of their condition, what should be checked at this time?
At present, the examination of patients with cervical spondylosis includes physical examination and auxiliary examination. Generally speaking, the physical examination should be examined by the doctor to make clear the existence of symptoms of cervical spondylosis, the more common ones include the existence of localized pressure points, the range of motion of the cervical vertebrae of the patient's body, as well as the examination of cervical vertebrae tests.
In addition, in order to better localize the diagnosis or differential diagnosis, it should also be combined with the actual situation of the patient's body, its sensory, motor and reflexes and other neurological aspects of the examination, for discretionary selection. The so-called motor examination mainly refers to the examination of the patient's muscle tone, muscle strength and gait.
The auxiliary examination is mainly imaging examination, including X-ray examination, magnetic **** vibration imaging, CT examination and other items. In addition, in order to better identify and diagnose the patient's disease, at this time, according to the actual needs of the patient, cerebrospinal fluid examination, electromyography and cerebral blood flow map and other tests. Take the most common X-ray examination as an example, the patient's cervical spine can be taken in the front, side and oblique flat film.
There are different purposes for why different orientations are used. The orthopantominal section is mainly to observe the presence of congenital anomalies such as atlantoaxial dislocation, odontoid fracture or absence. In addition, the patient's seventh cervical vertebral transverse process is observed for the presence of excessive length, cervical ribs, and widening or narrowing of the hook joints and intervertebral space. In the lateral section, the patient is observed for changes in the curvature of the cervical spine, narrowing of the intervertebral space, and calcification of the collateral ligaments. With the oblique section, the size of the intervertebral foramina and the osteophytes of the hooked vertebral joints can be better observed.
It is important to note that in the diagnosis of cervical spondylosis, patients should choose a regular hospital, as far as possible under the guidance of a professional physician, combined with the patient's body of clinical symptoms and signs, and choose the appropriate test items, patients should not be arbitrary subjective diagnosis, so as not to delay the clinical treatment of the disease.
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Cervical spondylosis is caused by cervical spine degeneration of blood vessels, nerve roots, spinal cord and other clinical syndromes caused by irritation or compression. Clinical examination should be based on the type of symptoms to consider the choice to dizziness and headache is best to take x-ray film (orthostatic, lateral and hyperextension and flexion lateral film), to the neck and shoulders of the upper limbs pain is mainly to take double oblique film, such as lower limb weakness is mainly to do MRI directly.
Cervical spondylosis main auxiliary examination: 1. X-ray examination of the cervical spondylosis to do a general judgment, for the osseous structure, see Is there any misalignment? The X-rays are mainly for the general judgment of cervical spondylosis. Is there any rotational displacement of the vertebrae? What is the condition of osteophytes? Is there any loss of disc height? Is there any narrowing of the intervertebral foramen? It can make preliminary judgment on tumor and tuberculosis in the middle and late stages.2. CT examination shows more clearly on tumor and tuberculosis in the early and middle stages, and it also makes localization measurements on misalignment, osteophyte and disc degeneration, and the data credibility is higher than that of X-ray. The compression of herniated disc on nerves or spinal cord can be shown more clearly and the degree of herniation can be measured, and according to the CT value, it can be judged whether it is calcified or not, which is better than magnetic resonance imaging (MRl).3. MRl shows the most clearly on cervical spine fascia, blood vessels, nerves, and intervertebral disc lesions, and it especially reacts well to the inflammatory lesions of the above structures with good characterization, and it shows the tumors, tuberculosis and metastatic foci clearly with high credibility of data.4. 4. In recent years, far-infrared thermography has been adopted by the pain department to provide an objective judgment for the fascial injury of neck and shoulder, and to provide reference for the functional lesions.
Physical examination of cervical spondylosis, mainly by the specialist's manipulation of touch, can check the misalignment, antipronation, rotational displacement, local tissue structure Zhang pressure, and can be corrected by manipulation. In recent years, pain rehabilitation specialists have adopted rehabilitation assessment techniques and stretch therapy evaluation techniques to address the limitations of cervical soft tissue injury to cervical spine function, which can easily and quickly lock a certain group of muscle groups, and through targeted treatment, each of which is highly effective! Physical examination is a useful supplement to the instrument-assisted examination, but can never replace the instrument-assisted examination.
In short, the physical examination and auxiliary examination, have their own focus, complement each other. The application of good, complementary. Physical examination, the use of good, can save large equipment CT and magnetic *** vibration of the inspection costs and inspection time. Auxiliary inspection can be clear whether there is a tumor, tuberculosis and positioning disc herniation, this is the physical examination can not be.
Wang is 32 years old, is a programmer, every day in front of the computer to write code, at least 8 hours of work, just graduated a few years, and did not feel any discomfort, but recently felt that the skin of the neck is particularly wooden, the left fingertips occasionally feel numb, to the hospital for a checkup, and found that the cervical curvature of the cervical vertebrae straightened, the discs have also occurred a herniation, compression, stimulation of the nerve root of the left side.
In the past, cervical spondylosis was a disease of the elderly, mainly due to degeneration of the cervical spine; hyperplasia of the hooked joints, intervertebral foramina compression of blood vessels, the herniated intervertebral discs compression, stimulation of the nerve root caused a series of symptoms.
But now many young people have cervical spondylosis, cancer is younger, why cervical spondylosis is also younger? Most of them are cell phones, computers, tablets cause trouble. Long-term head down on the cervical spine damage is very big.
What are the signs of cervical spondylosis?The symptoms of cervical spondylosis and cervical spondylosis subtypes are closely related:
1, nerve root type (the most common type): neck and shoulders, upper extremity headache, numbness, cycling upper extremities can be burning, pins and needles pain.
2, spinal cord type (the most serious type): lower limb weakness limp or paralysis, upper limb weakness, some patients will have myasthenia gravis.
3, vertebral artery type: most patients have dizziness, headache symptoms, memory loss; severe nausea, vomiting and cerebral infarction symptoms.
4, sympathetic type: irritability, dry mouth, insomnia, dreamy, headache, but also heart rate disorder, blood pressure instability.
Suspected cervical spondylosis, what examination should be done?To know what tests to do, you need to understand what you want to know.
Patients with cervical spondylosis need to observe the curvature of the cervical spine, whether the intervertebral space is narrowed, the vertebrae, the hooked joints, the intervertebral foramen of the bony hyperplasia; need to understand the intervertebral disc bulging, protruding, the nerve root compression, the narrowing of the spinal canal, the spinal cord, whether it is compressed and degeneration, necrosis.
Cervical X-ray, mainly to understand the bony results of the cervical spine, cervical hyperextension and hyperflexion can also understand the stability of the CT is also to observe these elements, but it is hundreds of times more radiation than the flat film, so to see the cervical spine bone, you can give preference to cervical spine flat film.
The above cervical plain films and CT can not reflect the spinal cord in the spinal canal, but the MRI can make up for this shortcoming, and can clearly show the shape of the spinal cord, the presence of abnormal signals, and the nerve roots can also be clearly shown.
So for patients with suspected cervical spondylosis, it is generally recommended to do cervical spine plain film, cervical spine magnetic **** vibration, rather than cervical spine CT.
Breathing guard ----- cervical spondylosis(10)