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CervicalSpondylosisDeshengWu,MDProfessorandChairmanDept.ofSpineSurgeryShanghaiEastHospitalTongjiUniversitySchoolofMedicineSpinalSequencecervicalvertebrathoracicvertebraelumbarvertebrapelvicCervicalSpineAnatomy•Atlas•Axis•Foramenprocessustransversi•Vertebralartery•LuschkajointTheconnectionbetweenthecervicalspine•ArthrosisIntervertebraldiscUncovertebraljointZygapophysealjoint•RetinaculumAnteriorlongitudinalligamentPosteriorlongitudinalligamentLigamentumnuchaecervicalnerve•Cervicalenlargement•Cervicalplexus（C1-C4）•Brachialplexus（C5-T1）•SympatheticnerveCervicaldiscdegenerationandsecondarypathologicalchangescausedbythesyndrome.DescriptionPathogenesis•Cervicaldegenerativechanges•Trauma•CervicalcongenitalspinalstenosisClassificationofcervicalspondylosisCervicalspondylosisCervicalspondyloticradiculopathyCervicalspondyloticmyelopathySympatheticcervicalspondylosisVertebralarterytypeofcervicalspondylosisMixedcervicalspondylosisCervicalRadiculopathy•Ruptureddisc•Hyperplasiaofuncovertebraljoint•ArticularhyperplasiaofjointsCervicalRadiculopathy•Painradiatingintothearm,neck,chest,and/orshoulders•Numbnessortinglinginfingersorhandsmayalsobepresent•Muscleweakness•Lackofcoordination,particularlyinthehands•MorecomfortableinthesupinepositionwiththeheadandneckslightlyflexedCervicalRadiculopathyFeaturesofCervicalRadiculopathy•Cervicalcompressiontesting•extremesofrotation,extension•motor,sensory,andreflexCervicalRadiculopathyCervicalRadiculopathyCTXRayCervicalRadiculopathyMRICervicalSpondyloticMyelopathyDegenerationof•Thejoints•Cervicaldiscs•Ligaments•ConnectivetissueCervicalSpondyloticMyelopathyPathophysiologicfactors•Staticmechanical•Dynamicmechanical•Spinalcordischemia•Staticmechanicalfactorsresultinthereductionofspinalcanaldiameterandspinalcordcompression•Dynamicmechanicalfactorsrelatetothefactthatthenormalmotionofthecervicalspinemayaggravatespinalcorddamageprecipitatedbydirectmechanicalstaticcompression•SpinalcordischemiaplaysaroleinthedevelopmentofCSM,particularlyinlaterstages.ButtheprecisemechanismisnotcompletelyunderstoodCervicalSpondyloticMyelopathy•Clumsyorweakhands•Legweaknessorstiffness•Neckstiffness•Paininshouldersorarms•UnsteadygaitCommonsymptomsCervicalSpondyloticMyelopathyCommonsignsCervicalSpondyloticMyelopathy•Atrophyofthehandmusculature•Hyperreflexia•Lhermitte'ssign•Sensoryloss•Hoffmann'ssign•Ankleclonus•Babinski'ssignCervicalSpondyloticMyelopathyVertebralArtery•Transverseforamenstenosis•Facetjointosteophytes•Instability•SpasmVertebralArterydizzinesstinnitusdeafheadache：swellingpaindysopiaCataplexyanddisturbanceofconsciousnessdyskinesiaVertebralarterytype-symptomsVertebralarterytype-onsetcharacteristicsVertebralArtery•Brainsymptomsmorethanlimbsymptoms.•Theimpactonthebrainwassignificantlygreaterthantheimpactonphysicalstrength.•Clinicalsymptomsandcervicalspinearecloselyrelated.•Itisthemostcomplextypeofcervicalspondylosis.AuxiliarycheckVertebralArteryVertebralarteryangiography:72%to85%haveabnormalfindings.Cerebralhematology:vertebral-basilarartery(occipitallead)visibleischemicchanges.TranscranialDoppler:candetectbloodflowdisorders.MRASympatheticnerveSymptomsoffacialfeaturesHeadsymptomsPeripheralvascularsymptomsSweatingdisorderAbnormalbloodpressureOPLL•Clinicalmanifestationsofcervicalspondyloticmyelopathyandcervicalspondyloticradiculopathy.•Thecauseisunknown.•Asianshaveahighincidence.•Imagingiseasytodistinguish.Differentialdiagnosis•cervicalspondyloticradiculopathy：Frozenshoulder、thoracicoutletsyndrome、lateralsclerosis、tumour•cervicalspondylodcmyelopathy：Cervicalfractures、Dislocation、tuberculosis、Ossificationofposteriorlongitudinalligament•Vertebralarterialtypeandsympathetictype：Causedizzinessofthedisease、coronaryinsufficiency、SubclavianischemicsyndromeTreatmentconservativetreatment•Jaw-ovvipitalbelt•Neckcollarbrake•massage•Physicotherapeutics•drugtherapyTreatmentoperativetreatmentAnteriorcervicalvertebraeresectionandfusionAnteriorCervicalDiscectomyAndFusionCervicaldiscreplacementPosteriorsingleopen-openvertebralcanalangioplastyTheposterioropeningofthevertebralcanalSurgicalindicationsTreatment•Patientsymptomsareheavyandconservativetreatmentisineffective.•identifieddiagnosis.•Thesymptomsofthepatientrecurrent,seriouslyaffectinglife.•Symptomsofprogressiveincrease.TreatmentanteriorcervicaldecompressionandfusionTreatmentTreatmentPosteriorsingleopen-openvertebralcanalangioplastyTreatmentCervicaldiscreplacementSummary•Thecauseofcervicalspondylosis•Theclassificationandclinicalmanifestationsofcervicalspondylosis•differentialdiagnosis•treatment