A 43-year-old female patient with intermittent headaches on the top of her head

Many older people report that they suffer from frequent headaches. There are many contributing factors to headaches. It may be caused by cold. If it is a long-term condition and is accompanied by discomfort in the shoulders and neck, it is likely caused by the cervical spine. So if you go to the hospital for a check-up because of a headache, if no discomfort is detected in the brain, you can consider checking the cervical spine, as it is likely caused by cervical spondylosis.

Cervical spondylosis, also known as cervical spondylosis, is a general term for cervical osteoarthritis, hypertrophic cervical spondylitis, cervical radiculitis, and cervical disc herniation. It is a disease based on degenerative pathological changes. It is mainly caused by long-term strain of the cervical spine, bone hyperplasia, or herniated disc, ligament thickening, which leads to compression of the cervical spinal cord, nerve roots or vertebral arteries, resulting in a series of clinical syndromes of functional disorders. It manifests as vertebral instability and loosening; nucleus pulposus protrusion or extrusion; bone spur formation; ligament hypertrophy and secondary spinal canal stenosis, etc., which stimulate or compress adjacent nerve roots, spinal cord, vertebral arteries, cervical sympathetic nerves and other tissues, causing a series of symptoms and signs.

Cervical spondylosis can be divided into: cervical type cervical spondylosis, nerve root type cervical spondylosis, spinal cord type cervical spondylosis, vertebral artery type cervical spondylosis, sympathetic nerve type cervical spondylosis, and esophageal compression type cervical spondylosis.

Clinical manifestations

The clinical symptoms of cervical spondylosis are relatively complex. The main symptoms include neck and back pain, upper limb weakness, numbness of fingers, lower limb weakness, difficulty walking, dizziness, nausea, vomiting, and even blurred vision, tachycardia and difficulty swallowing. The clinical symptoms of cervical spondylosis are related to the site of the lesion, the degree of tissue involvement and individual differences.

1. Cervical spondylotic radiculopathy

(1) It has typical radicular symptoms (numbness, pain), and the range is consistent with the area innervated by the cervical spinal nerves.

(2) Positive head pressure test or brachial plexus traction test.

(3) The imaging findings are consistent with the clinical manifestations.

(4) Pain point blocking has no significant effect.

(5) Diseases other than the cervical spine, such as thoracic outlet syndrome, carpal tunnel syndrome, cubital tunnel syndrome, and frozen shoulder, which are the main causes of upper limb pain.

2. Cervical spondylotic myelopathy

(1) Clinical manifestations of cervical spinal cord damage.

(2) X-rays show bone hyperplasia at the posterior edge of the vertebral body and spinal canal stenosis. Imaging confirmed the presence of spinal cord compression.

(3) Excludes amyotrophic lateral sclerosis, spinal cord tumors, spinal cord injury, multiple neuritis, etc.

3. Vertebral artery type cervical spondylosis

(1) A history of cataplexy. Accompanied by cervical vertigo.

(2) The neck rotation test is positive.

(3) X-rays show segmental instability or bone hyperplasia of the axis joint.

(4) Often accompanied by sympathetic nervous system symptoms.

(5) Exclude vertigo caused by eyes or ears.

(6) Except for the insufficiency of the basilar artery caused by compression of the vertebral artery segment I (the segment of the vertebral artery before entering the transverse foramen of C6) and the vertebral artery segment III (the segment of the vertebral artery before leaving the cervical vertebrae and entering the skull).

(7) Vertebral arteriography or digital subtraction vertebral arteriography (DSA) is required before surgery.

4. Sympathetic cervical spondylosis

The clinical manifestations include a series of sympathetic nervous system symptoms such as dizziness, blurred vision, tinnitus, numbness of hands, tachycardia, precordial pain, etc. X-rays show instability or degeneration of the cervical spine. Vertebral arteriography was negative.

5. Esophageal compression type cervical spondylosis

Bird-beak-like hyperplasia in front of the cervical vertebrae compresses the esophagus and causes dysphagia (confirmed by esophageal barium examination), etc.

6. Cervical spondylosis

Cervical spondylosis, also known as local cervical spondylosis, refers to pain in the head, shoulders, neck, and arms and corresponding tenderness points. There are no obvious degenerative changes such as intervertebral disc stenosis on X-rays, but there may be changes in the physiological curve of the cervical spine, intervertebral instability, and mild bone hyperplasia.