Professor Tan Mingsheng, deputy director of the Department of Orthopedics, China-Japan Friendship Hospital, specializes in spine surgery, mainly engaged in clinical, teaching and scientific research in the field of cervical spine, and has obtained 8 medical device invention patents. (Pictured on the left)
Liang Li, deputy chief physician of the Department of Orthopedics, China-Japan Friendship Hospital, has long been engaged in clinical orthopedic medical care, scientific research, and teaching. He has published many papers in domestic and foreign professional journals and often participates in domestic and foreign exchanges. (Picture on the right)
Hello, viewers! This is the live program of CCTV's "Road to Health". Today we are going to talk about surgical treatment of lumbar spondylosis.
Moderator: Is surgical treatment of cervical spondylosis dangerous?
Tan Mingsheng: With the in-depth basic research on cervical spondylosis, the continuous improvement of medical equipment and the continuous improvement of clinical surgical level, the success rate of cervical spondylosis surgery continues to increase, and it has now become a routine surgery in orthopedics. . In addition, about 90-95% of patients with cervical spondylosis belong to cervical type, nerve root type or vertebral artery type. This type of patients respond well to non-surgical treatment.
Liang Li: Non-surgical treatment is conservative treatment. Commonly used clinical conservative treatment methods include 1. Cervical traction. According to the location and degree of compression of the patient's spinal cord or nerve roots, cervical traction and local manual massage in different directions and weights are used. However, heavy and violent methods are Unsuitable. 2. Local physical therapy. 3. Treatment with traditional Chinese and Western medicine. Such as traditional Chinese medicine drugs for dispelling wind and unblocking collaterals, activating blood circulation and removing blood stasis, and nourishing kidneys and strengthening bones. Non-carrier anti-inflammatory and analgesic drugs of Western medicine, etc. The key is to eliminate the causes of cervical spondylosis such as long-term poor posture. A full course of treatment should also be done, generally a course of treatment lasts about 14 days. Cervical spondylosis is an aging disease caused by the degeneration of the human body. It is an inevitable phenomenon accompanying this aging process. At present, it is fundamentally impossible to reverse this process. However, the above conservative treatment methods can be used to reduce the patient's symptoms and By controlling the progression of the disease, a considerable number of patients will not need surgical treatment throughout their lives.
Moderator: What kind of situation requires surgical treatment?
Tan Mingsheng: Let’s look at a picture. Long-term and repeated occurrence of cervical spondylosis can cause cervical bone hyperplasia, and the pathological hyperplasia will fill up the nerve channels. These patients must be treated surgically. There are four clinical situations: 1. The nerves, spinal cord, and vertebral arteries are severely compressed by growths. Patients who have not relieved their symptoms after 1-3 courses of regular non-surgical treatment or for many years must undergo surgery. 2. Cervical spondylosis is accompanied by worsening symptoms of intervertebral disc herniation, and surgery is necessary if non-surgical treatment is ineffective. 3. Cervical spondylosis and vertebral instability require surgery. 4. If trauma aggravates the symptoms of cervical spondylosis, surgery should be considered.
Moderator: What examinations should patients do to determine the type of cervical spondylosis?
Tan Mingsheng: If the patient develops cervical spine symptoms, he should immediately go to the hospital to see a specialist for examination. The examination includes whether there is tenderness in the neck and whether the neck pain can induce numbness or pain in the limbs or induce Dizziness, nausea, etc. X-rays will then be taken. If necessary, a CT or MRI examination will be performed, so that the type and extent of the pathology can be further clarified, so as to decide whether and how to perform surgery.
Moderator: How is the operation performed?
Tan Mingsheng: Let’s look at a picture. Since the patient’s spinal canal and nerve root canal are compressed, the general principle of surgery is to relieve these compressions and remove these compression-causing substances through surgery, and then perform surgery. Restore the stability of the cervical spine. Let’s look at the picture again. The intervertebral disc herniates from the front, and the compressing object is removed through a small incision. This method has an immediate effect in relieving the patient’s pain. As shown in the picture, some patients with cervical spondylosis have missed the early treatment of intervertebral disc herniation, and even developed bone hyperplasia in the cervical vertebrae in the future. This kind of surgery requires the removal of the intervertebral disc and the removal of bone blocks in front that compress the nerves. As shown in the picture, some patients have spinal stenosis, coupled with repeated bone hyperplasia and ligament hypertrophy, causing nerve compression. The surgery is to expand the spinal canal from the rear and open the door to relieve the compression. A large number of clinical operations have proven that the operation is very safe.
In addition, surgical treatment of the upper cervical spine was previously considered a restricted area in medicine. When upper cervical spine surgery was carried out in my country in the 1970s, due to insufficient technology, the mortality rate even reached 40-50. Now, with the continuous in-depth research on the anatomy of the upper cervical spine, As well as the continuous improvement of medical equipment and the improvement of clinical surgical skills, the surgical results are good. Let’s look at two cases. 1. Ms. Pan from Beijing, 45 years old this year, suffered from severe dizziness and vomiting when she was 18 years old. She lay in bed for three days without getting up. Since then, she has spent most of her time in pain. In the past three years, I felt severe pressure on my head and shoulders. I went to many major hospitals for treatment. Due to the high risk of surgery, no surgery was performed. The patient had lost the courage to live. He went to our hospital for detailed examination and performed a very thorough decompression surgery. As shown in the picture, the patient had a congenital malformation. The first vertebra of the ring vertebra was fused with the skull, and the second vertebra was fused with the skull. The vertebrae and the third vertebra were also fused together, and pedicle fixation was performed after decompression surgery. The postoperative condition was very ideal, and the patient was very satisfied with the two-year follow-up.
Moderator: Mr. Yuan from Heilongjiang is 55 years old. I suffer from cervical spondylosis and type 2 diabetes. I underwent posterior open-door decompression surgery on the cervical spine. During the operation, I found black spots of necrosis in the spinal cord. After the operation, Although the symptoms have been relieved, my hands and feet are still numb and weak. How can I perform self-rehabilitation exercises in this case?
Liang Li: Self-rehabilitation exercises can be carried out, mainly including muscle strength, functional training, self-adjustment, rational use of medication, etc. However, because the patient has spinal cord injury, the recovery results may not be very satisfactory.
Tan Mingsheng: Remind patients that they should have the confidence to defeat the disease and continue to exercise their remaining nerve and muscle functions, because if the nerve and muscle functions are not exercised, they will naturally atrophy. For cervical spine patients, the general principle is to use immobilization, medication or physical therapy to relieve the inflammation during the onset and remission period. After alleviating the inflammation, consolidating the curative effect depends on the patient's exercise.
Moderator: Mr. Tang from Beijing is 64 years old. I always have numbness and shoulder pain. The doctor diagnosed it as frozen shoulder. It did not improve after treatment. Is frozen shoulder related to the cervical spine?
Liang Li: Frozen shoulder and cervical spondylosis are two completely different diseases, and their differential diagnosis is not difficult. They can be distinguished through X-ray examination, CT examination, and physical examination. Open.
Moderator: Ms. Shanxi Tian, ??41 years old. I often have pain in my cervical, thoracic, and lumbar spine, and my hands and feet are numb. Which part should be treated first during treatment?
Tan Mingsheng: It is common for people over the age of 40 to have some pain without nerve localization. If the patient has pain with nerve localization, treatment should focus on the area where the pain occurs.
Moderator: How long will it take for the patient to recover after surgery? How long is the hospital stay?
Liang Li: Generally speaking, you need to be hospitalized for 3-4 weeks after cervical spondylosis surgery. The clinical types include 1. Immediate reaction type, where symptoms are relieved immediately after surgery. Generally speaking, the onset of cervical spondylosis in this type of patients takes longer than 3-4 weeks. Not too long, the compression of the spinal cord and nerve roots is in a reversible stage. 2. Delayed response type. This type of patient does not have good results in the short term after surgery, but gradually recovers within a few months after surgery. Generally speaking, this type of patient has a longer onset of cervical spondylosis, and the spinal cord and nerve roots The compression was severe but the nerves were not necrotic. 3. One-pass reaction type, patients usually have symptoms relieved immediately after surgery, but symptoms return to pre-operative conditions about a week later. The proportion of this group of patients is very small. 4. Slow-response type. The patient's condition gradually recovers after surgery, but no longer recovers after 3-4 months. This type of patient generally has poor prognosis.
Moderator: Can cervical spondylosis be prevented?
Tan Mingsheng: It is impossible to completely prevent the development of cervical spondylosis, because the cervical spine will age like other organs of the human body. However, if it can be diagnosed early, the causes such as bad living habits and work Preventing bad posture, etc. can prevent the progression of the disease or prevent the condition from worsening to the point of surgery.
Specifically, there are the following points that need to be paid attention to in preventing cervical spondylosis: 1. Medically, it has been found that throat pain, inflammation and other conditions can cause the soft tissue of the upper cervical spine or the middle and lower cervical spine to become soft and weaken after inflammation, causing the cervical spine to lose stability. Sex can induce and aggravate cervical spondylosis, so patients with neck inflammation should be treated in time. 2. Sleeping posture and pillow selection are very important. The principle is that it should be suitable for the physiological curvature of the human spine, and the muscles of the whole body should be relaxed. The pillow for sleeping is generally a fist high. For patients who already have cervical spondylosis, if it is in the front space For patients with disc herniation, it is recommended that the pillow be slightly lower, which can reduce nerve compression. If the patient has thickened posterior ligaments, 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 as soon as possible. 4. Correct working habits are very important. We call on people or students who work at desks for a long time to get up every 1-2 hours to do appropriate activities or look far away.
Moderator: Ms. Gu from Henan, 65 years old, I have bone hyperplasia in the 2nd and 3rd cervical vertebrae, causing numbness in my right hand due to nerve compression. Do I need surgical treatment?
Liang Li: Patients should undergo further local examinations to see if there is disc herniation or bone hyperplasia in the cervical spine, as well as the exact location. After the site is identified, if the patient's symptoms are still severe after strict non-surgical treatment, we recommend surgery.
Tan Mingsheng: In principle, the area controlled by numbness of the 2-3 cervical vertebrae is different from that of the hand. The area controlled by the 2-3 cervical vertebrae is the shoulder, and the 5-6-7 cervical vertebrae are controlled by the shoulder. It is the area that is dominated that is related to the numbness of the hand.
Moderator: Mr. Li from Tangshan My father is 58 years old this year. CT scan showed cervical stenosis and lumbar disc herniation, and he was unable to walk. The doctor recommended surgery. Is surgery necessary?
Tan Mingsheng: As the population ages, there are more and more geriatric diseases. Both the cervical and lumbar spine have problems, which is medically called cervical and lumbar syndrome. First, a detailed physical examination should be carried out, and the patient's condition should be combined with the CT scans before deciding how to operate