Rao Raj
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Instr Course Lect. 2003;52:479-88.
Degenerative cervical disk disease is a ubiquitous condition that is, for the most part, asymptomatic. When symptoms do arise as a result of these degenerative changes, they can be easily grouped into axial pain, radiculopathy and myelopathy. While the pathophysiology of radiculopathy and myelopathy is better understood, the source of neck pain remains somewhat controversial. A discussion of the mechanisms of neck and suboccipital pain, and the chemical and mechanical factors responsible for neurologic symptoms is warranted. Examination of the patient with these symptoms will reveal variations in the clinical presentation. A thorough understanding of the natural history of these conditions will allow appropriate treatment to be carried out. The natural history of these conditions suggests that for the most part patients with axial symptoms are best treated without surgery, while some patients with radiculopathy will continue to be disabled by their pain, and may be candidates for surgery. Myelopathic patients are unlikely to show significant improvement, and in most cases will show stepwise deterioration. Surgical decompression and stabilization should be considered in these patients.
退行性颈椎间盘疾病是一种普遍存在的病症，在很大程度上无症状。当这些退行性改变导致症状出现时，它们很容易被归类为轴性疼痛、神经根病和脊髓病。虽然神经根病和脊髓病的病理生理学已得到更好的理解，但颈部疼痛的根源仍存在一定争议。有必要讨论颈部和枕下疼痛的机制，以及导致神经症状的化学和机械因素。对有这些症状的患者进行检查会发现临床表现存在差异。深入了解这些病症的自然史将有助于进行适当的治疗。这些病症的自然史表明，在大多数情况下，有轴性症状的患者最好不通过手术治疗，而一些神经根病患者将继续因疼痛而致残，可能适合手术治疗。脊髓病患者不太可能有显著改善，在大多数情况下会呈渐进性恶化。这些患者应考虑进行手术减压和稳定治疗。
