The Spatial Position Of The Upper Cervical Spine Abnormalities In Cervical Degenerative Diseases Related Research

Background. Cervical Spondylosis is a common and important chronic degenerative spinal diseases. Its basic concept is the intervertebral disc degeneration (including the adjacent vertebrates and their secondary changes). The disc degeneration results in stimulate or compression of nerve root, spinal cord, blood vessels and related tissues. Current studies of cervical spondylosis always focus on the lower cervical spine, but the upper cervical spine with large mobility and bearing most of the weight of head has not been concerned. As the junction between cervical spine and occipital bone, the shape and functions of upper cervical spine are very special. Atlanto-occipital joint is responsible for flextion and extension function of head, and atlantoaxial joint is responsible for rotation of head. There are a large number of receptors in area of joint connection of upper cervical spine, which makes it possible for upper cervical spine to transduction mechanical stimulation signals to the central nervous axis. Comparison with lower cervical spine, the signals from upper cervical spine can be transducted to CNS without much modification. MRI, CT can easily specific the compression areas for cervical spondylotic myelopathy and cervicalspondylotic radiculopathy, but for the other type of cervical spondylosis their contribution is much smaller. X-ray film is a cheap and convenient inspection method, but there is a lock of parameters with quantitative correlation with cervical spondylosis in addition to cervical curvature, spinal canal stenosis and neural canal stenosis. Currently, the clinical efficacy of non-surgical treatment of cervical spondylosis are quite different. There is a lock of quantitative evaluation index for clinical efficacy assessment. Therefore, to study the correlation between spatial location abnormalities of upper cervical spine and clinical symptoms by X-ray film is very important. It can provide theoretical basis for non-surgical treatment of cervical spondylosis.Objective.(1)To study the correlation between spatial location abnormalities of upper cervical spine and cervical symptoms.(2)To evaluate the clinical efficacy of Khan Kinetic Treatment, and to study the correlation between clinical efficacy and improvement of spatial location abnormalities of upper cervical spine.Methods.(1)306patients were involved in this study. Several X-ray parameers were measured based on the X-ray films of patients. The differences of these parameters between groups (based on gender, age, character of clinical symptoms diagnosis and VAS scores) were analyzed. The correlation between these parameters and NDI scores, VAS scores was also analyzed.(2)Patients who accepted KKT treatment and completed the courses were involved in the second study. The clinical efficacy of KKT was assessed by NDI scores and VAS scores. The correlation between clinical efficacy and improvement of spatial location abnormalities of upper cervical spine was also analyzed.Results.(1) The correlation between NDI score and VAS scores was significant (P<0.01). In mixed samples, the correlation between ATD and NDI scores was significant (correlation coefficient=-0.217, P=0.036). Factor of gender has no affection on the correlation between X-ray parameters and NDI, VAS scores. There was affection on the correlation between X-ray parameters and NDI scores by age, diagnosis, character of symptoms and other factors. The X-ray parameters with significant correlation with NDI scores includes:ATD, ATA, and RAA. Stepwise regression model showed that in the mixed sample, NDI scores were mainly affected by ATD. In group of cervical spondylosis, the contribution of ATD to NDI scores increased, and comparison with patients without cervical spondylosis, NDI scores was also affected by ATA. In cervical spondylosis patients with mild pain, ATD has no affection on NDI scores, but the contribution of ATA increased. In women with cervical spondylosis, the contribution of both ATA and ATD to NDI scores increased.(2) After treatment, the changes of ATA(P=0.000), NDI(P=0.000), VAS(P=0.000) was significant. The correlation between change of ATA and change of NDI scores was significant (correlation coefficient=0.230, P=0.009). The correlation between change of VAS scores and change of LADSD (correlation coefficient=0.173, P=0.049), ASA (correlation coefficient=0.281, P=0.001) were significant.Conclusion. ATD is a reflection of the changes in cervical curvature. With ATD becomes small, the cervical curvature becomes straight and the cervical symptoms become sever. In patients with cervical spondylosis, the affection is more significant. ATA is a reflection of axial rotation fixation of atlas. The accrescence of ATA can cause deterioration of cervical symptoms. In women patient or patients with mild pain, the affection was more significant.(2) As a non-invasive treatment, KKT is effective for patients with cervical symptoms but without indications for surgical treatment. The correlation between improvement of ATA and improvement of NDI scores was significant.