Professor Ruan Dike, director of the Department of Orthopaedics, Navy General Hospital, has in-depth research on spinal trauma, spinal deformity and spinal biomechanics, and has taken the lead in developing intervertebral disc transplantation in China, publishing 52 papers.
Li Jingyun, Deputy Chief Physician, Deputy Director of Orthopedics, Navy General Hospital, graduated from the Second Military Medical University, engaged in clinical teaching and research in orthopedics 18 years, and has rich clinical experience in orthopedic microsurgery.
Compere: Ask an expert to introduce the structure of cervical vertebra?
Ruan Dike: The anatomical map of the spine shows that the spine is straight from the front, S-shaped from the side and rich in anatomical structure from the back. The spine consists of cervical vertebra (7 segments), thoracic vertebra (12 segments), lumbar vertebra (5 segments), sacrum and coccyx, with intervertebral discs between the segments. There are abundant nerves and blood vessels on both sides of it, which are used to connect the upper and lower parts and play a buffering role.
Moderator: Where is the lesion of cervical spondylosis?
Li Jingyun: Cervical spondylosis is caused by the aging and degeneration of the contact pad between the two vertebral bodies of the cervical intervertebral disc, and the height between the segments becomes lower and thinner, thus causing the relaxation and jitter of the surrounding tissue structure, resulting in ligament hypertrophy and hyperosteogeny (bony spur), and the intervertebral disc will expand around after aging. These lesions will compress and stimulate nerve roots and vertebral arteries.
Moderator: Is the aging and degeneration of intervertebral discs only happening in old age?
Li Jingyun: Intervertebral disc is the earliest aging part of the whole body. Generally, people begin to age around 30 years old. The incidence rate of middle-aged and elderly people is 25% at the age of 50, 50% at the age of 60 and nearly 100% at the age of 70, which shows that the incidence rate is quite high.
Moderator: Why does cervical spondylosis feel different?
Ruan Dike: There are various clinical manifestations of cervical spondylosis, which can be roughly divided into five types: cervical spondylosis, characterized by repeated stiff neck; Cervical spondylotic radiculopathy is characterized by numbness of arms and fingers, accompanied by persistent pain. The numbness caused by poor posture can be relieved after exercise, which is different from the numbness of cervical spondylosis. Cervical spondylotic myelopathy, characterized by numbness of both feet, chest tightness and unstable walking; Non-arterial cervical spondylosis, manifested as dizziness and headache; If you have the above two symptoms, it is mixed cervical spondylosis.
Moderator: What if there is an inspection?
Li Jingyun: Patients should first go to the specialties (orthopedics) of big hospitals for examination, such as X-ray examination, CT examination, magnetic resonance examination, neuroelectrophysiological examination and so on.
Moderator: What are the treatments?
Ruan Dike: Treatment methods are divided into non-surgical treatment and surgical treatment. Non-surgical treatment: cervical traction (preferably in the hospital), collar fixation (limiting the range of motion of the neck and reducing the stimulation to nerves and spinal cord), functional exercise (bending neck, shrugging shoulders and turning shoulders, 8- 10 times for each movement), manual massage (not suitable for patients with cervical spondylotic myelopathy), and internal and external use of Chinese and western medicines (sticking plaster and taking painkillers).
Li Jingyun: Surgical treatment: anterior discectomy, interbody fusion, vertebroplasty, posterior laminectomy and decompression, vertebral artery decompression.
Moderator: What are the indications for cervical spondylosis surgery?
Ruan Dike: In principle, ordinary patients can be relieved by non-surgical treatment. Only patients with cervical spondylosis of spinal cord type, nerve root type and vertebral artery type can be treated surgically.
Moderator: Ms. Wang of Gansu has suffered from cervical spondylosis 1 for many years, and the feeling of traction through cervical vertebra is OK. Does she need surgery?
Li Jingyun: If the effect of non-surgical treatment is good, we can continue, but if it is cervical spondylotic myelopathy, it is better to operate as soon as possible, because this type of disease develops rapidly, so it is better to do it early than late.
Moderator: Ms. Luo from Jiangxi suffered from cervical spondylosis 10 for many years. She just started to have a headache. Recently 1 has been dizzy for many years, and I can't walk steadily. How should we treat her?
Ruan Dike: She may have mixed cervical spondylosis. First, she should be examined. If it is cervical spondylotic myelopathy, I suggest surgery.
Moderator: Mr. Li from Hainan suffers from hypertension, and his medication is well controlled. Sometimes he feels dizzy. How to distinguish it from the symptoms of cervical spondylosis?
Li Jingyun: Blood pressure should be monitored during dizziness. Generally, dizziness caused by hypertension is related to blood pressure fluctuation, that is, headache is greater than dizziness, while cervical spondylosis is mainly dizziness, accompanied by numbness of limbs and unstable walking. The two are handled in different ways.
Moderator: Mr. Li of Shaanxi Province has numbness in both lower limbs, pain and discomfort with unstable walking for 5 months. He was diagnosed with cervical spondylotic myelopathy by the hospital and worried about surgery. He thought he could still work, so he kept putting off the operation. He started massage 1 month ago, and now he feels weak and aggravated in his lower limbs. He fell twice, and it is difficult to get on and off the bike and ride. The result of magnetic resonance imaging is a signal of spinal cord injury. Should an operation be performed immediately in this case?
Ruan Dike: We suggest that patients with cervical spondylotic myelopathy should be treated by surgery immediately and pay attention to massage to avoid aggravating their condition.
Moderator: Mr. Li of Henan always hears noises when his neck turns, sometimes accompanied by headaches. Is it cervical spondylosis? How to treat it?
Li Jingyun: Sound is the sound between tendon and bone, which is an aging and degenerating change. You can go to the hospital for a checkup.
Moderator: Mr. Duan from Guizhou was diagnosed with cervical spondylosis. The doctor said that fusion and fixation were needed. I heard that the neck movement is not flexible after this operation. Are there any other surgical methods?
Ruan Dike: For example, anterior cervical decompression and fusion is to cut off the diseased intervertebral disc and then cut off the bone on the pelvis, but after fusion, it can't move. Now both cervical intervertebral disc transplantation and allogenic intervertebral disc transplantation can move, and the effect is not bad.
Moderator: Will there be rejection in allogeneic transplantation?
Li Jingyun: There is no immune rejection in intervertebral disc allograft.
Moderator: What is the effect of transplantation?
Li Jingyun: According to my observation, it's not bad.
Moderator: Mr. He Nanguo has been suffering from diabetes 10 years, and recently suffered from cervical spondylosis. The doctor suggested an operation. Is it suitable for surgery now?
Li Jingyun: Diabetes is not a contraindication for surgery. As long as blood sugar is well controlled before operation, infection can be prevented after operation.
Moderator: Ms. Kong from Inner Mongolia has the same symptoms as the previous ones, but the doctor's diagnosis is cervical spinal stenosis. If an operation is performed, what operation is appropriate?
Ruan Dike: She can do "single-door" laminoplasty, such as horizontal lateral position.
Moderator: Ms. Zhang's father in Jiangsu is over 70 years old this year. She has suffered from cervical spondylosis for three years. The doctor suggested an operation and worried about postoperative paralysis. Is the operation risky?
Li Jingyun: As you get older, the risk of surgery will increase. It is recommended that patients go to a big hospital to find an experienced doctor for surgery.
Moderator: What is the success rate of the operation?
Ruan Dike: Generally, 85%-90% of symptoms can be relieved after operation.
Moderator: What anesthesia was used in the operation?
Ruan Dike: The methods of surgical anesthesia are different according to different hospitals. Generally, it is branch anesthesia, cervical plexus anesthesia and general anesthesia. Mahjong gradually replaced the other two kinds of anesthesia.
Moderator: How long will the operation take? How long does it take to stay in the hospital? Do you need blood transfusion?
Ruandick: It usually takes 2-3 hours, and the hospitalization time is about 3 weeks. If the patient's bleeding volume does not exceed 300-400 ml, blood transfusion will not be given, but plasma will be used instead.
Moderator: How much is the cost of the operation?
Ruan Dike: The cost of surgery varies greatly across the country. The total cost of our hospital is about 6,543,800 yuan.
Moderator: Mr. Wu from Shanxi suffered from cervical spondylosis for 2 years. He suffered from a myocardial infarction four months ago. He went to the hospital to see some doctors, and the doctors said that it was not suitable for surgery now, and some doctors said that surgery could be done. Should an operation be performed in this case?
Li Jingyun: Surgery mainly depends on the onset time. In principle, surgery for more than 6 months is the safest, but if the condition is serious, surgery can still be performed.
Moderator: Ms. Li from Tianjin suffers from cervical disc herniation and spinal canal stenosis. Now she is dizzy badly, but she still has tinnitus. Is it related to cervical spondylosis? How to treat it?
Ruan Dike: The clinical manifestations of cervical spondylosis of vertebral artery type are dizziness, headache, nausea, vomiting and tinnitus. It can be treated by local traction or plastering. If the symptoms can't be relieved, it is recommended to go to the otolaryngology department for examination.
Moderator: Mr. Song in Beijing often has shoulder and neck pain, but he can get better by himself. He also went to the hospital to see a doctor. The doctor said it was cervical spinous hyperplasia. Does the spur need to be surgically removed?
Li Jingyun: Bone spur is a pathological change caused by the aging of intervertebral disc. If nerves and blood vessels are compressed, they can be surgically removed. If it doesn't cause any symptoms, there is no need for treatment.
Moderator: Mr. Jiang from Tianjin has been suffering from cervical spondylosis for more than ten years, and he often has dizziness and headache. He was diagnosed with cervical spinal stenosis and insufficient blood flow in the cervical artery. How about an operation?
Ruan Dike: His condition should be surgical treatment, which can also improve the phenomenon of insufficient blood supply to the brain after operation.
Moderator: Ms. Cui/KLOC-0 from Inner Mongolia had cervical spondylosis surgery in 1993, and now she feels her legs are not very flexible. Is this the sequela of the operation?
Li Jingyun: It's hard to say. Postoperative symptoms should be alleviated, otherwise adjacent intervertebral discs may have lesions. I suggest further inspection.
Moderator: Mr. Wang of Heilongjiang suffered from cervical spondylosis three years ago because of trauma, and now his hands are numb. On one occasion, his right lower limb could not feel the temperature. Can he be treated without surgery? There is also lumbar disc herniation. Is it caused by cervical spondylosis?
Ruan Dike: It is suggested that the upper limbs can be treated by traction, and if the effect is not good, they can also be treated by surgery, while the lower limbs need X-ray and ct examination before choosing the treatment method.
Moderator: Is there any interaction between cervical spondylosis and lumbar disc herniation?
Ruan Dike: Some doctors call this condition "neck-waist syndrome", but most doctors still think that both diseases are independent diseases, but they have certain influence.
Moderator: There is a tumor in the cervical spinal canal of Ms. Zhao in Jilin. How should it be treated? Surgery is more dangerous. Is there any medicine that can be treated?
Ruan Dike: There is a tumor in the spinal canal that does not belong to the treatment scope of cervical spondylosis. Tumors can be divided into benign and malignant. If the clinical symptoms are not serious, you can observe for a period of time before choosing a treatment method. If it is a malignant tumor, it is recommended to operate as soon as possible.
Moderator: Mr. Wang's hand in Shanxi has been numb for 2 years, and it is heavy and light. He didn't go to the hospital, but he can relieve himself. In the past two months, his chest has tightened, and he feels that his chest is tied by something. At the same time, he felt that he was walking on an uneven road. His feet were tight, and he didn't record any activity. When crossing the threshold, his toes touched the threshold. Is it cervical spondylosis?
Li Jingyun: This patient has a long course of disease. Nerve roots and spinal cord are compressed and stimulated. It may be cervical spondylotic myelopathy. It is recommended to go to the hospital for examination immediately.
Moderator: Ms. Zhang, Jiangsu Province, has felt very uncomfortable in her neck in the past two years, and sometimes she feels dizzy. Will she develop cervical spondylosis in the future
Ruan Dike: People who often work at their desks are more likely to get cervical spondylosis, but her condition doesn't seem to be cervical spondylosis. I suggest that she do head and neck exercises or go to the hospital for examination.
Moderator: Ms. Shen from Shaanxi has suffered from cervical hyperplasia for 20 years, with backache and backache. Now her shoulder blade hurts badly, and massage can relieve it, but it still hurts afterwards. Can this symptom be treated surgically?
Li Jingyun: Suggest her to have non-surgical treatment, such as physical therapy and acupuncture.
Moderator: Ms. Zheng from Liaoning has been undergoing cervical surgery for half a year. What posture should a doctor take when sleeping? What kind of pillow do you use? What kind of bed do you choose?
Ruan Dike: In principle, the height of pillow after operation is not a big problem, as long as you fall asleep properly. Generally, the height of pillow is based on shoulder width, but long-term pillow height is harmful to vertebral body.