Manual therapy combined with posterior percutaneous endoscopic cervical decompression for the treatment of cervical spondylotic radiculopathy / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy and safety of manual therapy combined with posterior percutaneous endoscopic cervical decompression(PECD) in the treatment of intractable cervical spondylotic radiculopathy.@*METHODS@#From May 2016 to May 2018, 23 CSR patients who responded poorly to conservative treatment for at least 6 weeks underwent the combination management. Firstly, the patients received the posterior percutaneous endoscopic cervical decompression routine care for the following 4 weeks and manual therapy for another 4 weeks. A total of 23 patients were followed up, including 14 males and 9 females, the age ranged from 29 to 78 years old with an average of (50.30±12.28) years, the course of disease was 3 to 24 months with an average of (9.74±5.76) months. The lesion segment involved C4,5 in 4 cases, C5,6 in 13 cases, C6,7 in 6 cases. The visual analogue scale (VAS), neck disability index (NDI), changes of cervical physiological curvature and interbody stability, adverse events were observed before and after operation. The follow-up time points were before operation, 1 day after operation and 1, 3 and 6 months after operation.@*RESULTS@#All patients successfully completed the operation and manual treatment for 4 to 8 times. Among the 29 cases, 23 patients were followed up for more than 6 months. There was no spinal cord and nerve root injury during the treatment and follow-up. Operation time was from 80 to 120 min with a median of 90 min;intraoperative blood loss was from 35 to 80 ml with a median of 50 ml. NDI, VAS of neck, shoulder and arm each period after operation were significantly lower than those before PECD(P<0.05), while there were no significant improvement in cervical physiological curvature and target segment intervertebral space height(P>0.05);there was no significant change in interbody stability (P>0.05). After received the manual therapy, NDI significantly decreased (P<0.05), however, there was no significant difference in VAS of neck, shoulder and arm, physiological curvature of cervical spine and intervertebral space height of target segment compared with that before manual treatment (P>0.05);there was no significant change in interbody stability (P>0.05).@*CONCLUSION@#Manual therapy combined with PECD in the treatment of intractable cervical spondylotic radiculopathy can not only quickly improve the symptoms, but also alleviate the residual symptoms after PECD safely and effectively, and can not cause obvious signs of accelerated instability of cervical adjacent segments in the short term.

Correlation analysis between position of head, cervical curvature classification and balance of cervical spine through lateral plain radiograph measurement / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the relationship between position of head, cervical curvature type and associated cervical balance parameters in a neutral looking-forward posture.</p><p><b>METHODS</b>Cervical lateral X-rays of 60 patients with cervical spondylosis were selected from January to December 2015. There were 22 males and 38 females with an average age of (35.5±10.9) years old. The measured parameters included cervical curvature type, McGregor slope, C2 lower end plate slope, T1 slope, center of gravity to C7 sagittal vertical offset (CG-C7 SVA), and C2 to C7 sagittal vertical offset (C2-C7 SVA). The parameters were analyzed using Spearman correlation.</p><p><b>RESULTS</b>The cervical curvature type was significantly correlated with C2 lower endplate slope, C0-C2 angle (total degree of C2 lower endplate slope plus McGregor slope), CG-C7 SVA and T1 slope (<0.05), but it was not significantly correlated McGregor slope (>0.05). C2 lower endplate slope and C2-C7 SVA (r=0.87) were significantly (<0.05) correlated with CG-C7 SVA (<0.05).</p><p><b>CONCLUSIONS</b>There was certain some relationship among position of head, cervical curvature type and associated cervical balance parameters in a neutral looking-forward posture. The center of gravity of the head would backwards shift following faced upward. A position of extension with posterior-shifting of the head would suggest that it may be accompanied with a relatively normal lordosis of the cervical spine. Some patients with abnormal curvature showed slightly bended head in the natural posture. Health education toward these people would be meaningful to restore the balance of their neck.</p>

Application of mechanical measurement in assessment of neck pain and manual therapy / 中国骨伤

Manual therapy is one of the effective methods in treating neck pain. It has certain advantages in the short term to ease the symptoms of neck pain. In recent years, using different mechanical sensors and imaging equipment with computer software, the researchers found the difference of cervical activity between health adult and patients with neck pain. They also analyzed the kinematics, magnitude of force, stress and strain of the related structure and other mechanical parameters during cervical manipulation. These biomechanical researches revealed the functional anomaly caused by neck pain, reflect the safety of cervical manipulation, explain the abnormal stress of neck pain and the adjusting role of manipulation. Relatively speaking, these studies are too basic, and their analysis also are limited for the stress and strain about internal tissue. Study to aim directly at above problems will have important significance in understanding neck pain and standardizing manipulation therapy.

Study on the clinical value of cervical spondylosis with articulatio atlantoepistrophica sublaxation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the effect of articulatio atlantoepistrophica sublaxation on the pathogenesis of cervical spondylosis, and provide a thread for diagnosis and treatment of cervical spondylosis with manipulation.</p><p><b>METHODS</b>There were two groups in the study, which were non cervical spondylosis group and cervical spondylosis group. There were 333 patients in cervical spondylosis group, included 119 males and 214 females with the mean age of(48.11±12.21) years old. The patients were recruited from clinic service of orthopaedics in Shuguang Hospital between March 2006 and December 2008. There were 73 subjects in non cervical spondylosis group, included 18 males and 55 females with the mean of(45.99±11.47) years old. The subjects were recruited from undergraduate students, postgraduate, advanced study persons, and community personnel. The position relation of the atlanto axial joint was observed by cervical X rays with opening position, and the incidence rate of articulatio atlantoepistrophica sublaxation was compared between two groups, and their clinical characteristics were analyzed.</p><p><b>RESULTS</b>The incidence of articulatio atlantoepistrophica sublaxation in cervical spondylosis group was 81.38%(271/333)and was more than non cervical spondylosis group(<0.01). Furthermore, the pattern of the articulatio atlantoepistrophica sublaxation in cervical spondylosis group was complicated and diversified, which was 50.55% (137/271)with single moving sublaxation, 7.01%(19/271) with revolving sublaxation, 42.44%(115/271) with single moving and revolving sublaxation.</p><p><b>CONCLUSIONS</b>The articulatio atlantoepistrophica sublaxation may be a X ray diagnostic indication to the cervical spondylosis, which should be grouping studied in clinic. It will provide guidance for the diagnosis and treatment of cervical spondylosis.</p>

Biomechanics applied in traditional Chinese traumatology manipulation for treating cervical spine diseases / 医用生物力学

Traditional Chinese traumatology manipulation (TCTM) has some prominent advantage for treating cervical spine diseases in clinic, thus the biomechanical research on TCTM could possess important clinical and theoretical significance. The studies on biomechanical mechanism of TCTM for treating cervical spine diseases in recent years were reviewed from various aspects, and biomechanical issuessuch as the force measurement of TCTM, the different operation types of TCTM (i.e. tendon-soothing maneuver, bone setting manipulation), the TCTM effect on cervical tissues (i.e. vertebral body, intervertebral discs, muscles, blood vessels) were also investigated, trying to provide some biomechanics theoretical evidence and guidance for treating cervical spine diseases with TCTM in clinic.

In vivo study on the body motion during the Shi's cervical reduction technique with 3D motion capture / 中国骨伤

<p><b>OBJECTIVE</b>The clinical effect of the Shi's cervical reduction technique for cervical spondylosis and related disorders has confirmed, however, there were few studies on the body motion during manipulation in vivo study. This study is to summary the law of motion and the motion characteristics of the right operation shoulder, elbow, knee and ankle joints by data acquisition and analysis with the 3D motion capture system.</p><p><b>METHODS</b>The markers were pasted on the head, trunk, left and right acromion, elbow joint, wrist joint inner side and the outer side of the inner and the outer side and the lateral upper arm, forearm lateral, anterior superior iliac spine, posterior superior iliac spine, trochanter, femoral and tibial tubercle, inner and outer side of knee, ankle, fibular head, medial and lateral in first, 2,5 metatarsal head, heel and dual lateral thigh the calf, lateral tibia of one manipulation practioner, and the subject accepted a complete cycle of cervical "Jin Chu Cao and Gu Cuo Feng" manipulation which was repeated five times. The movement trajectory of the practioner's four markers of operation joints were captured, recorded, calculated and analyzed.</p><p><b>RESULTS</b>The movement trajectories of four joints were consistent, while the elbow joint had the biggest discrete degree. The 3D activities of the shoulder and elbow were more obvious than other two joints, but the degree of flexion and extension in the knee was significantly greater than the rotation and lateral bending.</p><p><b>CONCLUSION</b>The flexibility of upper limb joint and stability of lower limb joint are the important guarantees for the Shi's cervical reduction technique, and the right knee facilitated the exerting force of upper limb by the flexion and extension activities. The 3D model built by the motion capture system would provide a new idea for manipulation teaching and further basic biomechanical research.</p>

Construction of a human cervical spine with bilateral vertebral artery fluid-solid coupling model / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To construct a human cervical spine with bilateral vertebral artery fluid-solid coupling model.</p><p><b>METHODS</b>Helical CT images under the principle of reverse engineering and meshed in finite element model（FEM） related software were used to establish a human cervical spine with bilateral vertebral artery fluid-solid coupling model. In the process of modeling of vertebral body, vertebral artery, ligament, intervertebral disc, cartilage and endplate large anatomic data and cadaver experiments results were referenced. From the morphology and function the simulation of model with real physiological status was tested.</p><p><b>RESULTS</b>The study showed that the stress concentration on the surface of vertebral body and the blood wall of the bilateral vertebral artery, and the result of the volume flow rate-time curve of bilateral vertebral artery of the model were consistent with the published literatures. This model was well consistent with the clinical phenomenon.</p><p><b>CONCLUSION</b>The three-dimensional FEM of the human cervical spine established by the introduced method has been effectively verified. The modeling method would provide a new tool for research on the cervical spine biomechanics.</p>

Development of Chinese version vertigo symptom scale (VSS): reliability and validity / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To develop a Chinese version of Vertigo Symptom Scale (VSS-C) and to examine its reliability and validity.</p><p><b>METHODS</b>The VSS was translated into Chinese and developed a Chinese version VSS (VSS-C) with the consent of the author. The VSS-C scale was tested in 52 subjects with cervical spondylosis of vertebral artery type (CSA group) and 21 healthy subjects (control group). In CSA group VSS-C scale and SF-36 scale investigation was performed for 2 times with 1 week interval, after receiving 1-week orthopedic rehabilitation the patients were evaluated with the VSS-C and SF-36 scale; while subjects in control group received the investigation twice in two weeks. The reliability of the scale was evaluated with Cronbach's alpha method and the correlation between SF-36 scale and the VSS-C were also evaluated for the validity.</p><p><b>RESULTS</b>The internal consistency of VSS-C was good with Cronbach's alpha of 0.886. Test-retest reliability was also very good with an intraclass correlation coefficient (ICC) between two time points, being 0.970 for VSS-C, 0.965 for VSS-AA and 0.992 for the VSS-VER. Regarding concurrent validity, significant low correlation was found between the VSS-AA and VSS-VER (r=0.379, P<0.05). Significant expected correlation was detected between the VSS-C and SF-36 (r>0.5, P<0.05) . The independent-samples t test results (t=6.261, P<0.01) of the CSA group and the control group showed that the VSS-C was able to distinguish healthy people from CSA patients. The paired-samples t test results (t=5.513, P<0.01) showed that VSS-C reflected the improvement of patients after treatment of Chinese massage manipulation.</p><p><b>CONCLUSION</b>The Chinese version of VSS has a high comprehensibility, internal consistency and validity, and it can be a useful instrument for evaluation of patients with cervical spondylosis of vertebral artery type in China.</p>

Fluid-structure interaction analysis on hemodynamics of vertebral arteries during physiological activities of cervical spine / 医用生物力学

Objective To further understand the biomechanical relationship between activities of cervical spine and blood flow of vertebral artery (VA) by developing the VA finite element model and calculating the fluid-structure interaction. Methods Based on the normal model of cervical spine and the developed C0-T1 finite element model with bilateral VA, the flexion and extension, right and left lateral bending, right and left axial rotation movement of cervical spine at physiological velocity were simulated. The effects of cervical activities on stress of vertebral arterial wall were observed, and the biomechanical interaction between the vessel wall and fluid was calculated by fluid-structure interaction equation to obtain the hemodynamic parameters. Results The maximum stress was usually concentrated on the both sides of C2 transverse foramen, where the second arc of vertebral arterial wall protruded into the cranial direction during cervical activities. The maximum strain of the vessel wall was most obvious during the extension and lateral bending movement, with strain ratio of 23.04% and 35.5%, respectively. The maximum stress on the vessel was located in the position of contralateral transverse foramen during lateral bending movement, while the maximum strain on the vessel was located in the position of ipsilateral transverse foramen during rotation movement. In aspect of cervical spine range of motion (ROM), the minimum volume flow rate occurred within 30%-40% of the physiological ROM. The volume flow rate-time curve of bilateral VA was similar during flexion and extension movement, when the circulation of flow rate was completed for two times within 0.5 s. The peak and valley of ipsilateral blood flow in volume flow rate-time curve occurred earlier than that of contralateral blood flow during lateral bending movement, while the results of rotation movement were opposite. Conclusions The obtained stress features of bilateral VA vessel and the law of the volume flow rate-time curve validated the experimental results with those in the literature, which could reasonably explain the clinical phenomenon. The established model would provide an ideal platform for researches on vertebral artery-related diseases.

Effect of osthole on proliferation of neonatal rat osteoblast and the relative mechanism research / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effects of osthole on proliferation of neonatal rat osteoblast and the mechanism.</p><p><b>METHODS</b>Ten 24 hours old SD rats were executed by dislocating. The cranium of rats were removed and cut into blocks of 1 mm x 1 mm size. After digested by trypsin for 15 min, the cranium were digested by type I collagenase for one hour two times. The mixed cells were cultured in thermostat incubator with 5% CO2 under the condition of 37 degrees C. To identify the cells, ALP staining and alizarin red staining were performed after cultured 48 h and 28 d. The osteoblasts were randomly divided into five groups. Cells were treated with osthole at concentrations of 100, 50, 25, 12.5, 0 micromol/L. CCK-8 method was used to evaluate the proliferation after 24 h,48 h and 72 h. The expression of PCNA and beta-catenin protein were detected through the method of Western Blot after one week.</p><p><b>RESULTS</b>The cells had irregular shapes and showed typical features of osteoblast. The results of ALP staining and alizarin red staining were both positive. CCK-8 detection showed that the osthole with final concentration of 100 micromol/L inhibited the proliferation of osteoblast after 24 h, while the osthole with final concentrations of 50 micromol/L and 25 micromol/L displayed the inhibition effect after 48 h. The osthole of 12.5 micromol/L had no obvious influence on the proliferation of osteoblast. The result of Western Blot showed that osthole reduced the expression of PCNA and beta-catenin protein in a dose-dependent manner.</p><p><b>CONCLUSION</b>The osthole with final concentrations of 100, 50, 25 micromol/L inhibited the proliferation of osteoblast (P < 0.05). The osthole with final concentrations of 12.5 micromol/L had no obvious influence on the proliferation of osteoblast (P > 0.05). These findings demonstrate that osthole may inhibit the proliferation of osteoblast by regulating the Wnt/beta-catenin signaling in osteoblast.</p>

Study on the correlation between "Gucuofeng and Jinchucao" and cervical spondylosis / 中国骨伤

<p><b>OBJECTIVE</b>To explore the relation between "Gucuofeng and Jinchucao" and cervical spondylosis.</p><p><b>METHODS</b>From March 2006 to October 2011,333 patients with cervical spondylosis were collected in the study as cervical spondylosis group; 30 subjects of control group come from student of Shuguang Hospital and other health volunteer. There were 119 males and 214 females with a mean age of (48.11 +/- 12.21) years in cervical spondylosis group and there were 6 males and 24 females with a mean age of (45.27 +/- 10.12) years in control group. In aspect of the symptom and sign, dynamic palpation, X-ray examination wer performed to find the incidence rate of "Gucuofeng and Jinchucao" in two groups.</p><p><b>RESULTS</b>There was significant difference in symptom and sign, dynamic palpation, X-ray examination between two groups (P<0.01). In cervical spondylosis group, "Gucuofeng and Jinchucao" occurred in 293 cases (87.99%),there was significant difference compared with control group (P<0.01).</p><p><b>CONCLUSION</b>Cervical "Gucuofeng and Jinchucao" is one of pathological point of cervical spondylosis,and it can provide a guidance for the diagnosis and treatment of cervical spondylosis.</p>

Comparison of the activity and yield rate of osteoblast obtained by different digestion methods / 中国骨伤

<p><b>OBJECTIVE</b>To compared the activity and yield rate of osteoblast obtained by different collagenase digestion methods, to find a better way to extract osteoblast for the experimental researches of osteoporosis.</p><p><b>METHODS</b>Ten 24-hour-old SD rats were were euthanized. The cranium of rats were removed and cuted into blocks of 1 mm x 1 mm size. After digested by trypsin for 15 min, all the cranium were divided into two equal parts, and randomly divided into two groups which would be digested by type I collagenase and type II collagenase separately for two times. The rat cells of the two groups were cultured in thermostat incubator with 5% CO2 under the condition of 37 degrees C. The primary culture osteoblasts were counted by using a haemacytometer after digestion and 72 hours later. The second generation osteoblasts cultured 48 h were dyed by NBT/BCIP staining solution, and were detected by quantitative measurement with PNPP.</p><p><b>RESULTS</b>The cells had irregular shapes. The results of cell counting showed that the cell number of type I group was larger than type 11 group. Alkaline phosphatase dyeing were positive. Detecting of alkaline phosphatase using the method of PNPP showed that the absorbance value in type I group were higher than type II group (P<0.05).</p><p><b>CONCLUSION</b>Two types of collagenase are both suitable for the in vitro culture of rat osteoblasts. The activity and yield rate of osteoblasts in type I group are higher which could provide more stable seed cells for the treatment of osteoporosis.</p>

Clinical significance of vertebral artery MRA to vertebral artery type of cervical spondylosis' diagnosis and treatment / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical significance of vertebral artery magnetic resonance angiography (MRA) to vertebral artery type of cervical spondylosis' diagnosis and treatment.</p><p><b>METHODS</b>There were two groups in the study, which were observation group and control group. There were 53 patients in observation group,including 19 males and 34 females,with a mean age of (52.51 +/- 11.29) years. There were 30 subjects in control group,including 10 males and 20 females,with a mean age of (48.11 +/- 12.21) years. Based on the vertebral artery MRA picture,the course and caliber of vertebral artery were compared between two groups.</p><p><b>RESULTS</b>The abnormal incidence of course and caliber of vertebral artery in observation group was higher than that of control group, which had statistic difference (P=0.000). Furthermore, the patterns of abnormal course and caliber of vertebral artery in observation group were complicated and diverse, but the regional circuity and stegnosis was the most common pattern,about 47.18%(25/53). The cause of circuity and stegnosis was vertebra Gu-Cuofeng,about 43.41% (23/53).</p><p><b>CONCLUSION</b>The vertebral artery MRA provides a guidance for the diagnosis of abnormal course and caliber of vertebral artery in vertebral artery cervical spondylosis.</p>

Retrospective analysis and prevention strategies for accidents associated with cervical manipulation in China / 中国骨伤

<p><b>OBJECTIVE</b>To review previously reported injuries cases which were associated with cervical manipulation in China, and to describe the risks and benefits of the therapy.</p><p><b>METHODS</b>Relevant case reports, review articles, surveys, and investigations regarding treatment of cervical spondylosis with cervical manipulation involving accidents and associated complication were retrived with a search of the literature from SinoMed, CNKI, CQVIP, and Wanfang digital databases between 1979 to March 2011. The data were extracted and statistically analyzed.</p><p><b>RESULTS</b>Total of 150 cases of injury reported in 40 articles corresponded the inclusion criteria. Accidents occurred in 156 cases,of them,syncope was in 45 cases (28.85%), mild spinal cord injury or compression was in 34 cases (21.79%), nerve root injury was in 24 cases (15.38%), ineffective or symptom increased was in 11 cases (7.05%); cervical spine fracture was in 11 cases (7.05%), dislocation or semiluxation was in 6 cases (3.85%), soft tissue injury was in 3 cases (1.92%), serious accident was 22 cases (14.70%, including paralysis, death and cerebrovascular accident). In cases of serious accident, 12 cases (54.55%) had the other primary diseases. Types of related manipulation including rotation reduction (42.00%, 63 cases), rubbing points or muscle resulting strong stimulation (28.00%, 42 cases). 100 cases (66.67%) obtained cured or basically recovered results, 21 cases (14.00%) improved, 4 cases (2.67%) deterioration and 5 cases (3.33%) died.</p><p><b>CONCLUSION</b>It is imperative for practitioners to complete the patients' management and assessment before manipulation. That the practitioners conduct a detailed physical examination and make a correct diagnosis would be a pivot method of avoiding accidents. Excluding contraindications and potential risks, standardizing evaluation criteria and practitioners' qualification, increasing safety awareness and risk assessment and strengthening the monitoring of the accidents could decrease the incidence of accidents.</p>

Systematic review of clinical randomized controlled trials on manipulation treatment for vertebral artery type of cervical spondylosis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of the manipulation treatment for vertebral artery type of cervical spondylosis and analyze the current status of clinical study.</p><p><b>METHODS</b>To retrievie the PubMed, OVID, Cochrane library, CBM-disc database, CNKI database, VIP database, 265 literatures of the manipulation treatment of vertebral artery type of cervical spondylosis were collected, including 251 literatures Chinese and 14 literatures English. Among the literatures, 5 studies of Chinese literatures accorded with inclusion criteria. Cochrane systematic review was used to quality evaluation; and 5 studies were used RevMan 4.2 for Meta analysis of literature.</p><p><b>RESULTS</b>Five documents included a total of 736 patients. Summary of the literature combined OR for the cure rate was 2.93, 95% CI was [2.10,4.08]. Summary OR for the combined efficiency was 3.99, 95% CI was [2.47,6.44]. Manipulation group's cure rate of vertebral artery type of cervical spondylosis was efficient and clearly superior to the other therapies. Expect of the manipulation, the traction and the drugs, hereinafter referred to as "other therapies" (P < 0.01).</p><p><b>CONCLUSION</b>At present, documents included in this study have shown that manipulation treatment on vertebral artery type of cervical spondylosis is safe, both cure rate and the effective rate are much better than other therapies; but the incorporation of a limited number of documents and the quality is not very high, the conclusion is still uncertain, high-quality evidence should be needed to be further validated.</p>

Enlightenment by chiropractic's developing mode / 中国骨伤

Traditional Chinese spinal manipulative therapy (TCSMT) and Chiropractic are similar in treating related with spinal disease, but they keep different characteristics of themselves. Although Chiropractic's "Subluxation" and TCSMT's "Jin Chu Cao and Gu Cuo Feng" theory have not be widely recognized, yet Chiropractic has already have official cooperation with WHO,and has launched "WHO Basis of Chiropractic Training and Security Guide" which would promote the project further research. Comparatively, TCSMT has mature theoretical system and satisfactory clinical effectiveness, but it's hard to global spreading formally and legally. By means of cogitation of the TCSMT'S basic theories and clinical applications, this paper aims to analyze the inadequacy aspects of it, and hope to borrow some Chiropractic's advantage to TCSMT's global spreading. And I wish this paper could be helpful for relative doctors and researchers.