Liang Li, deputy chief physician of Orthopedics Department of China-Japan Friendship Hospital, has been engaged in clinical orthopedics medical treatment, scientific research and teaching for a long time, published many papers in professional journals at home and abroad, and often participated in domestic and international exchanges. (right)
Hello, audience friends! This is CCTV's live program "The Road to Health". Today we are going to talk about the surgical treatment of lumbar spondylosis.
Moderator: Is it dangerous to treat cervical spondylosis by surgery?
Tan: With the deepening of basic research on cervical spondylosis, the continuous improvement of medical equipment and the continuous improvement of clinical operation level, the success rate of cervical spondylosis surgery has been continuously improved, and it has now become a routine operation in orthopedics. In addition, about 90%-95% of patients with cervical spondylosis belong to cervical type, nerve root type or vertebral artery type, and these patients respond well to non-surgical treatment.
Liang Li: Non-surgical treatment is conservative treatment. The commonly used conservative treatment methods in clinic are 1 and cervical traction. According to the position and degree of compression of spinal cord or nerve root, cervical traction and local massage in different directions and weights are adopted, but heavy and fierce methods are not suitable. 2, local physical therapy. 3. Chinese and Western medicine treatment. Such as traditional Chinese medicine drugs for expelling wind and dredging collaterals, drugs for promoting blood circulation and removing blood stasis, drugs for tonifying kidney and strengthening bones, etc. Non-carrier anti-inflammatory and analgesic drugs in western medicine. The key is to get rid of the causes of cervical spondylosis, such as long-term bad posture. You also have to do a complete course of treatment, generally a course of treatment is about 14 days. Cervical spondylosis is an aging disease caused by human degeneration, and it is an inevitable phenomenon accompanying this aging process. At present, this process can not be fundamentally reversed, but through the above conservative treatment methods, the symptoms of patients can be alleviated, the development of the disease can be controlled, and a considerable number of patients can survive without surgery.
Moderator: What kind of situation must be treated surgically?
Tan: Let's look at a picture. The long-term recurrence of cervical spondylosis can make cervical vertebrae proliferate, and the proliferated pathological substances will fill the nerve channels. This kind of patient must be treated by surgery. There are four clinical situations: 1, the nerve, spinal cord and vertebral artery are severely compressed by hyperplasia, and patients who have not been relieved for many years or 1-3 courses of regular non-surgical treatment must be operated. 2. Cervical spondylosis with aggravated symptoms of disc herniation needs surgery if non-surgical treatment is ineffective. 3, cervical spondylosis, spinal instability must be operated. 4. Surgery should be considered when trauma aggravates the symptoms of cervical spondylosis.
Moderator: What tests should patients do to determine the type of cervical spondylosis?
Tan: If the patient has symptoms of cervical vertebra, he should go to the hospital for examination immediately, including whether there is tenderness in the neck, whether the pain in the neck can induce numbness or pain in the limbs or induce dizziness and nausea. Then an x-ray examination is needed. If necessary, do CT or magnetic resonance examination to further clarify the pathological type and degree, and then decide whether and how to operate.
Moderator: How is the operation going?
Tan: Let's look at a picture. Because the patient's spinal canal and nerve root canal are compressed, the general principle of surgery is to relieve these compressions, remove these substances through surgery, and then restore the stability of cervical spine. Let's look at another picture. The intervertebral disc protrudes from the front and the compressed object is taken out through a small incision. This method can relieve the patient's pain immediately. As shown in the figure, some patients with cervical spondylosis missed the treatment of early disc herniation, and even appeared cervical hyperosteogeny in the future. This operation needs to remove the bone block that compresses the anterior nerve while clearing the intervertebral disc. As shown in the figure, some patients with spinal canal stenosis, combined with repeated bone hyperplasia and ligament hypertrophy, make the nerves compressed. The operation is to enlarge the spinal canal from the rear, that is, to open the door to relieve oppression. A large number of clinical operations have proved that the operation is very safe. In addition, the surgical treatment of upper cervical spine was previously considered as a medical taboo. In the 1970s, the mortality rate even reached 40%-50% due to the imperfect technology in upper cervical spine surgery in China. Now, with the continuous in-depth study of upper cervical anatomy and the continuous improvement of medical equipment, coupled with the improvement of clinical operation level, the operation effect is good. Let's look at two cases. 1. Ms. Pan from Beijing is 45 years old this year. /kloc-When she was 0/8 years old, she suffered from particularly severe dizziness and vomiting. She stayed in bed for three days. Since then, she has spent most of her time in pain. In the past three years, she has felt severe pressure on her head and shoulders. She has been treated in many big hospitals. Because the operation was risky, she didn't have the operation. The patient has lost the courage to live, and went to our hospital for a very thorough decompression operation through detailed examination. As shown in the figure, the patient is congenital malformation, and the first vertebra of the annulus vertebra is fused with the skull, and the second vertebra and the third vertebra are also fused together. Pedicle fixation was performed after decompression surgery, and the postoperative situation was very ideal. The patient was also satisfied with the two-year follow-up situation.
Moderator: Mr. Yuan from Heilongjiang, 55 years old, I suffer from cervical spondylosis and type II diabetes. After cervical decompression, I found black spots of necrosis in the spinal cord. Although the symptoms were relieved after operation, the hands and feet were still numb and weak. How can I do self-rehabilitation exercise in this situation?
Liang Li: Self-rehabilitation exercises can be carried out, mainly including muscle strength, functional training, self-regulation and rational drug use. However, because the patient has spinal cord injury, the recovery result may not be ideal.
Tan: Remind patients to have the confidence to overcome the disease and exercise the remaining nerve and muscle functions persistently, because nerve and muscle functions will naturally shrink without exercise. The general principle of exercise for patients with cervical spondylosis during the onset and remission period is that the inflammation should be relieved by braking, medication or physical therapy during the onset period, and the curative effect should be consolidated by the patient's exercise after the inflammation is relieved.
Moderator: Mr. Tang from Beijing is 64 years old. I'm always numb and my shoulders hurt. The doctor diagnosed scapulohumeral periarthritis and it didn't get better after treatment. Is scapulohumeral periarthritis related to cervical vertebra?
Liang Li: Scapulohumeral periarthritis and cervical spondylosis are completely different diseases, so it is not difficult to differentiate them. It can be identified by X-ray examination, CT examination and physical examination.
Moderator: Ms. Tian Shanxi, 4 1 year old. My cervical vertebra, thoracic vertebra and lumbar vertebra often hurt, and my hands and feet are numb. Which part should be treated first when treating them?
Tan Mingsheng: Over 40 years old, it is common to have some pain without nerve localization. If patients have neuropathic pain, they should be treated mainly at the site that causes the pain.
Moderator: How long does it take for the patient to recover after the operation? How long will you be in hospital?
Liang Li: Generally speaking, patients with cervical spondylosis need to be hospitalized for 3-4 weeks after operation. The clinical types are 1 and immediate response, and the symptoms are relieved immediately after operation. Generally speaking, the onset time of cervical spondylosis will not be too long, and the compression of spinal cord and nerve roots is in a reversible stage. 2. Delayed reaction type. The patient's effect was not good in the short term after operation, but he gradually recovered within a few months after operation. Generally speaking, this patient has a long onset of cervical spondylosis, and the spinal cord and nerve roots are heavily compressed but the nerves are not necrotic. 3. After the reaction, the patient usually relieves the symptoms immediately after the operation, but after about one week, the symptoms return to the preoperative condition. This part of patients accounts for a small proportion. 4. Slow-response type, the patient's condition gradually recovers after surgery, but it will not recover after 3-4 months, and the effect of such patients after recovery is generally poor.
Moderator: Can cervical spondylosis be prevented?
Tan: It is impossible to completely stop the development of cervical spondylosis, because the cervical vertebra will age like other organs of the human body. However, if we can diagnose it early and prevent bad living habits, poor working posture and other reasons, we can prevent the disease from developing or make it not deteriorate to the extent of surgery. Specifically, the prevention of cervical spondylosis should pay attention to the following points: 1. It is found in medicine that the pain and inflammation of the throat can make the soft tissue of the upper cervical vertebra or the middle and lower cervical vertebra soften and decrease the muscle strength after inflammation, which makes the cervical vertebra lose its stability and can induce and aggravate cervical spondylosis. Therefore, patients with cervical inflammation should be treated in time. 2. The choice of sleeping position and pillow is very important. The principle is to adapt to the physiological flexion of the human spine and relax the muscles of the whole body. Sleeping pillows are usually one punch high. For patients with cervical spondylosis, if the anterior intervertebral disc protrudes, it is suggested that the pillow be slightly lower, which can relieve nerve compression. If the posterior ligament is thickened, it is recommended that the pillow be slightly higher, which can also relieve nerve compression. 3. Avoid head and neck trauma. If you have head and neck trauma, you should go to the hospital for treatment. 4. Correct work habits are very important. We appeal to people or students who work at their desks for a long time to get up every 1-2 hours to do appropriate activities or overlook.
Moderator: Ms. Gu from Henan, 65 years old. I have hyperosteogeny in the 2nd-3rd cervical vertebra, and my right hand is numb due to nerve compression. Need an operation?
Liang Li: The patient should have further examination in the local area to see if there is disc herniation or cervical hyperosteogeny, and the exact location. If the patient's symptoms are still serious after strict non-surgical treatment, we recommend that the patient undergo surgical treatment.
Tan: In principle, the 2-3 cervical vertebra is different from the area dominated by hand anesthesia. 2-3 cervical vertebra is mainly shoulder, and 5-6-7 cervical vertebra is related to hand anesthesia.
Moderator: Teacher Li from Tangshan, my father is 58 years old. CT examination showed that the cervical spinal canal was narrow, the lumbar intervertebral disc was prominent and it was impossible to walk. The doctor suggested an operation. Do you have to have an operation?
Tan: With the aging of the population, there are more and more diseases among the elderly. There are problems with both cervical vertebrae and lumbar vertebrae, which is medically called cervical lumbar syndrome. First of all, a detailed physical examination should be carried out, combined with the patient's condition and CT film, and then how to operate.