Cervical spondylosis, also known as cervical syndrome, is a common and frequently occurring condition among middle-aged and elderly individuals. This condition is a syndrome caused by inflammation resulting from cervical disc atrophy, narrowing of the intervertebral spaces, or cervical hyperplasia, which stimulates or compresses the cervical nerve roots, the cervical spinal cord, the vertebral arteries, or the sympathetic nerves.
I. Clinical Subtypes and Manifestations
Cervical spondylosis can occur in the facet joints, atlanto-axial joints, and vertebral bodies. Depending on the location of the hypertrophy, various symptoms may arise.
Cervical Spondylosis, Radicular Type: In this type, degenerative hyperplasia at the posterolateral aspect of the vertebral body, the anterior margin of the facet joint, or the posterior aspect of the atlantoaxial joint causes a narrowing of the intervertebral foramen, leading to symptoms involving the cervical or brachial plexus nerve roots. When the lesion is located at C5 or above, symptoms may include neck-shoulder or neck-occipital pain and sensory disturbances in the occipital region; when the lesion is located below C5, symptoms include neck stiffness and limited range of motion; unilateral or bilateral radiating pain in the neck, shoulders, and arms, accompanied by symptoms such as numbness in the fingers, cold extremities, heaviness and weakness in the upper limbs, and dropping objects. Neck movement is asymmetrically restricted; numbness or increased pain in the upper limbs and hands occurs during extension or rotation toward the affected side. Patients may experience referred pain and secondary tender points along the inner margin of the scapula, in the scapular region, or in the shoulder.
Cervical Spondylosis, Spinal Cord Type: This type results from hypertrophy of the posterior vertebral margins, protruding intervertebral discs, and thickening of the posterior longitudinal ligament, which intrude into the spinal canal, narrowing its anteroposterior diameter and causing symptoms of spinal cord and nerve root compression. Symptoms include numbness, weakness, and limpness in one or both upper or lower limbs, as well as tremors in the neck and arms. The condition may even manifest as incomplete spastic paralysis of varying degrees, such as difficulty moving, a clumsy gait, and unsteadiness while walking, leading to bedridden status. In severe cases, respiratory distress may occur, accompanied by increased muscle tone in the limbs, hyperactive tendon reflexes, diminished or absent superficial reflexes, and may present with knee and ankle clonus or a positive Babinski sign.
Cervical Spondylosis, Vertebral Artery Type: Also known as the ischemic type, this form is caused by lateral degenerative hyperplasia of the atlantoaxial joints, which leads to twisting, spasm, or compression of the vertebral artery, resulting in insufficient blood supply. Due to ischemia in the inner ear and brain, patients may present with symptoms such as neck and shoulder pain, occipital pain, dizziness, nausea, vomiting, positional vertigo, sudden fainting, dropping objects, tinnitus, hearing loss, and blurred vision. These symptoms are often triggered or exacerbated by turning or tilting the head to a certain position.
Cervical Spondylosis, Sympathetic Type: In this type, due to hypertrophy of the facet joints accompanied by subluxation or irritation of the vertebral arteries, the sympathetic nervous system is stimulated, leading to symptoms such as occipital pain, a sensation of heaviness in the head, dizziness or migraines, palpitations, chest tightness, cold extremities, low skin temperature, or warmth in the hands and feet, and soreness and swelling in the limbs. Generally, there is no radiating pain or numbness in the upper extremities; however, in some patients, symptoms such as retrobulbar pain, blurred vision, photophobia, tearing, rhinorrhea, a sensation of a foreign body in the throat, facial sweating, and pain in the anterior chest region may also occur.
Mixed Cervical Spondylosis: Clinically, the above types rarely occur in isolation; the most common presentation involves the simultaneous presence of symptoms from two or more types.
A cervical X-ray may reveal loss or reversal of the physiological cervical lordosis, cervical scoliosis, narrowing of the intervertebral spaces, sclerosis and hypertrophy of the facet joints and vertebral margins, narrowing of the facet joint spaces, abnormal vertebral alignment, and anterior slippage of the vertebral bodies and articular processes. Vertebral artery angiography is helpful in diagnosing vertebral artery-type cervical spondylosis, as it reveals signs such as tortuosity and narrowing of the vertebral arteries. In patients with myelopathic cervical spondylosis, imaging may reveal incomplete or complete obstruction of the subarachnoid space at the site of the lesion.
When diagnosing cervical spondylosis, it is essential to rule out conditions such as spinal cord or nerve root tumors, syringomyelia, cervical tuberculosis, rheumatoid spondylitis, cervical ribs, anterior scalene syndrome, supraclavicular fossa tumors, and primary or metastatic tumors. A misdiagnosis not only renders treatment ineffective but may also lead to adverse consequences.
II. Treatment of Cervical Spondylosis
Tuina Massage: Based on a clear diagnosis, treating cervical spondylosis with Tuina massage often yields good results, with particularly significant effects observed in the radicular, vertebral artery, and sympathetic nerve types.
(1) Tuina Massage Techniques: One-Finger Zen pushing, pressing, kneading, grasping, stretching, rotational stretching, rubbing, hand-pushing, shaking, and vibrating techniques, among others.
(2) Acupoint Selection: Fengchi, Dazhui, Dazhu, Jianjing, Tianzong, Tianzhu, Quchi, Shousanli, Waiguan, etc.
(3) Tuina massage should be combined with functional neck exercises: ① Forward and backward flexion; ② Lateral flexion to the left and right; ③ Circular rotation to the left and right; ④ Self-traction.
Acupuncture Treatment:
(1) Body Acupuncture: Select acupoints such as Dazhui, Dazhu, Fengchi, Jianjing, Quchi, and Waiguan;
(2) Technique: The “dispersing” method is recommended. However, acupoint selection must be based on syndrome differentiation to ensure efficacy.
(3) Auricular Acupuncture or Auricular Pressure Bead Therapy: Select acupoints for the shoulder, neck, and Shenmen. Supplementary acupoints include Subcortical, Spleen, and Kidney.
Electroacupuncture: Select the same acupoints as for body acupuncture; apply electrical stimulation for 30 minutes, preferably using alternating dense and sparse waveforms.
Traditional Chinese Medicine (TCM) Syndrome Differentiation and Treatment: For patients with cervical spondylosis, combining the above treatment methods with oral medications that tonify qi and blood, dispel wind and cold, and promote blood circulation and unblock meridians can enhance therapeutic efficacy. ① Qi and Blood Deficiency Type: Tonify qi and nourish blood; treat with modified Ba Zhen Decoction. ② Wind-Cold Type: Warm the meridians, dispel wind, and disperse cold; treat with modified Wu Tou Decoction. ③ Qi Stagnation and Blood Stasis Type: Regulate qi, invigorate blood, and unblock the meridians; treat with modified Shen Tong Zhu Yu Decoction. ④ Liver and Kidney Yin Deficiency Type: Nourish the kidneys and liver; treat with modified Zuo Gui Pills or You Gui Pills.