| Background Cervical spondylosis is one of the most frequent and common diseases.Generalized cervical spondylosis is a general symptom of cervical spondylosis,which is caused by degeneration of cervical intervertebral disc and secondary pathological changes,resulting in peripheral decoupling,and a neuromuscular related symptom.It is also called Cervical Syndrome.According to rough statistics,in China,the incidence of cervical spondylosis is about 8.1% to19.1%.According to the clinical manifestation of cervical spondylosis,there are many types of cervical spondylosis,of which the cervical spondylosis with sympathetic symptoms is a special one.The so-called cervical spondylosis with sympathetic symptoms,is due to a variety of cervical spine lesions(such as instability,degeneration,disc herniation,inflammation,etc.)stimulating the cervical sympathetic ganglion,those causing dizziness,blurred vision,headache,insomnia,chest tightness,bloating,hot flashes and so on.There are still many controversies about the naming,typing,forming mechanism,pathogenesis,diagnostic standard and treatment standard of this special type of cervical spondylosis.The mechanism research is one of the hot spots and also the difficulties of cervical spondylosis with sympathetic symptoms.Combined with the published literature,there are mainly cervical intervertebral instability theory,humoral factor theory,posterior longitudinal ligament sympathetic nerve fiber theory,joint around proprioceptive stimulation theory,neck Ruffini body stimulation theory and so on.To date,there is no perfect hypothesis that can explain the pathogenesis of this special type of cervical spondylosis.In recent years,the popular theory of sympathetic nerve fiber stimulation of posterior longitudinal ligament of cervical spine has been demonstrated.The basic experiment shows that the stimulation of the longitudinal ligament can cause the changes of the sympathetic ganglion potential in the neck and induce the sympathetic nerve symptoms.Based on this theory,the excision of posterior longitudinal ligament was selected in the operation to fully decompress the cervical spinal cord and block the sympathetic reflex pathway.Some scholars have explored the relationship between the cervical sympathetic fibers and the sympathetic symptoms around the vertebral artery,heart and other effectors.However,this theory is not perfect and immature.This study is to further study this mechanism.Objective 1.On the basis of previous studies,we further clarify the morphological distribution of sympathetic nerve on the posterior longitudinal ligament,and provide necessary evidence for subsequent experiments and other types of research.2.To further clarify the corresponding sympathic symptoms of sympathetic nerve effector caused by sympathetic nerve fiber irritation on the posterior longitudinal ligament of the cervical spine.Through the selection of two effectors of respiration and blood pressure,the conduction relationship between sympathetic nerve fiber and effector in cervical sympathetic ganglion to the posterior longitudinal ligament was identified,and the pathogenesis of cervical spondylosis with sympathetic symptoms was clear.3.Through these experiments,we will consolidate one hypothesis of the pathogenesis of cervical spondylosis with sympathetic symptoms: the pathogenesis of sympathetic fibers on the cervical posterior longitudinal ligament.4.By studying the pathogenesis of cervical spondylosis with sympathetic symptoms,we can clarify the corresponding relationship between symptoms and the location of lesions,so as to provide an objective basis for accurate location and treatment of cervical spondylosis with sympathetic symptoms in clinic.Methods Experiment One: To study the distribution of sympathetic fibers in the posterior longitudinal ligament of the cervical spine.The posterior longitudinal ligament and sympathetic ganglion of 10 New Zealand white rabbits were harvested by operation,and the morphological study was carried out by different staining methods.The experimental rabbits were divided into two groups,5 in each group.The first group was cut through the cervical sympathetic ganglion,and the second groups were cut for the posterior longitudinal ligament of the cervical spine.The animal experimental New Zealand rabbits were used for ear vein anesthesia,proper placement in cervical operation,the full extension of the cervical spine,preoperative skin disinfection.The skin was cut,the cervical vertebra and the surrounding appendage structure were exposed and the corresponding tissues were cut.After removing the material,Formaldehyde Solution was quickly placed.The tissue staining of HE,NPY and S100 was performed,and the reading piece analysis was performed to identify the evidence and nerve source of sympathetic fibers on the posterior longitudinal ligament of cervical spine.Experiment Two: To study the changes in the effect organs of New Zealand white rabbits(respiratory frequency)when electric stimulation of the sympathetic ganglion of different parts of the neck.35 New Zealand white rabbits were needed.The experimental group was divided into 3 groups,10 in each group and 5 in the control group.After the auricular vein anesthesia,the chest respiratory transducer was bundled.The cervical and surrounding appendages were exposed to the cervical sympathetic ganglion of different parts of New Zealand white rabbits in experimental animals,and the changes of respiratory frequency were measured.Anaesthetized drugs were used to block neuroganglionic stimulation again,and the changes of respiratory frequency were recorded again.The relationship between the different cervical sympathetic ganglion and the respiratory frequency was determined.Experiment Three: To study the cervical sympathetic ganglion in different parts of the electric stimulation,the change of blood pressure in experimental animals and the corresponding relationship with the ganglion.35 rabbits were divided into 3 groups and one control group.Ten was in each experimental group and five in the control group.After anesthesia,the cervical and surrounding accessory structures were fully revealed,and catheterization and transducer connection were carried out.The changes of blood pressure were measured by electrical stimulation(50m V)on the cervical sympathetic ganglion of different parts of New Zealand white rabbits.Anaesthetized drugs were used to block the nerve to stimulate again,and the blood pressure was recorded again.To determine the relationship between the cervical sympathetic ganglion and the blood pressure in different parts of the neck.Statistical Method: the measurement data involved were expressed as mean standard deviation(x + s).SPSS 21 statistical software was used for statistical analysis,and the method of paired t test was used in the group.The data of the 3 experimental groups(the upper,middle and lower sympathetic ganglia of the neck,respectively)and the control group(0m V stimulation group)were tested by Dunnett-t test.Set the test level a=0.05,when P<0.05 regard as difference is statistically significant.Results Experiment ONE: The distribution and origin of sympathetic nerve fibers in the posterior longitudinal ligament were studied by morphology.The results showed that(1)the staining of the posterior longitudinal ligament of the cervical spine was positive by observing the stained sections.The density of the positive reaction is low,suggesting that the distribution of sympathetic fibers is less.(3)not all the posterior longitudinal ligaments of the experimental animals could detect positive nerve staining,suggesting that the distribution of sympathetic fibers on the posterior longitudinal ligament is not universal.(4)after specific NPY staining,the nerve fibers in the surface of the posterior longitudinal ligament were observed to be the same as the source of the sympathetic ganglion in the neck.Experiment TWO: The corresponding changes in the respiratory frequency were observed by the cervical sympathetic ganglion with different segments of stimulation.The results showed that the blood pressure change in superior cervical ganglion stimulation group was statistically significant after stimulation(P<0.05).After stimulation in the middle and lower cervical ganglia and the ratio of the control group,the respiratory frequency was not statistically significant(P>0.05).The ganglia of each group were stimulated again after block,and there was no statistical significance in the change(P>0.05).Experiment THREE: The corresponding changes of blood pressure were observed in the cervical sympathetic ganglion by electric stimulation of different segments.The results showed that the corresponding changes of blood pressure could be observed in the stimulation group of the superior cervical ganglion and the middle ganglion,which was statistically significant compared with the control group(false stimulation)(P<0.05).The blood pressure was not statistically significant(P>0.05)after the stimulation of the lower cervical ganglion and the control group.The ganglia of each group were stimulated again after block,and there was no statistical significance in the change(P>0.05).Conclusion 1.The basic morphological study confirmed the sympathetic nerve in the posterior longitudinal ligament.This study further confirmed the morphological characteristics of the sympathetic fibers in the posterior longitudinal ligament.The objective fact of the presence of sympathetic fibers on the surface of the posterior longitudinal ligament of the cervical spine was confirmed by multiple nerve staining techniques.And the source of nerve fiber is homologous to the cervical sympathetic ganglion.2.Through the effector study,we identified the corresponding relationship between sympathetic ganglia and symptoms in different parts of the experiment.It was proved that the stimulation of the sympathetic nerve of different segments of the cervical segment could cause the corresponding sympathic nerve symptoms(with respiratory frequency and blood pressure as the object).The nerve fibers in the longitudinal ligament after drug block can not trigger the corresponding symptoms again.According to the corresponding relationship between the sympathetic nerve fibers on the cervical sympathetic ganglia and the posterior longitudinal ligament,the following conclusions are drawn: cervical spondylosis can induce different sympathetic symptoms on different longitudinal segments of the longitudinal ligament.Among them,the cervical 4/5 segment lesion corresponds to the change of the respiratory frequency,and the cervical 5/6 segment lesion corresponds to the change of blood pressure.The reasonableness of the pathogenicity of the sympathetic fibers in the posterior longitudinal ligament was confirmed.3.Animal experiments have certain guiding significance for clinical diagnosis and treatment.The relationship between the respiratory frequency and the blood pressure and the sympathetic ganglion of the neck was found in our experiments.Through these results,the cervical lesion segments can be accurately identified by different sympathetic symptoms.This discovery has brought new insights into the clinical diagnosis and treatment of cervical spondylosis with sympathetic nerve symptoms. |
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