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Objective:To explore the effect of intermittent angle traction on the supine position combined with acupoint application on the changes of cervical radiculopathy related biological parameters.Methods:Randomized controlled trial. A total of 100 patients with radiculopathy cervical spondylosis treated in the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from February 2019 to February 2021 were selected and randomly divided into observation group ( n=50) and control group ( n=50). Patients in the control group were given conventional treatment with western medicine, and patients in the observation group were given acupoint application combined with supine intermittent angle traction combined with treatment. Both groups were treated for 3 months. The Japanese Orthopaedic Association Spinal Cord Function (JOA), Cervical Disability Index (NDI), Pain Visual Analogue Score (VAS) and the changes in intervertebral foramen volume of two groups were compared before and after treatment. The difference in clinical efficacy between the two groups after treatment was observed. We took a thin spiral CT film of the patient's cervical spine, established a three-dimensional finite element model of the cervical spine, and compared the differences in related indicators between the two groups before and after treatment. Results:The total effective rate was 94.0% (47/50) in the observation group and 70.0% (35/50) in the control group, and there was a significant difference between the two groups ( χ2=9.76, P=0.002). After treatment, the JOA score in the observation group was significantly higher than that of the control group ( t=6.23, P<0.01), the NDI score, VAS score were significantly lower than those in the control group ( t values were 5.17,9.13, P<0.01), the intervertebral foraminal volume [(8.45±1.27)mm 3vs. (7.18±1.38)mm 3, t=4.79] was significantly higher than that of the control group ( P<0.01), and C 4-7 cervical vertebra flexion [(7.15±0.87)° vs.(5.64±0.78)°, t=9.14], retroflexion [(8.53±0.73)° vs. (7.15±0.68)°, t=9.78], sidebend [(6.57±0.71)° vs. (5.28±0.67)°, t=9.34], rotated [(7.89±0.52)° vs. (6.54±0.48)°, t=13.49] were significantly higher than those in the control group ( P<0.01); C 4-7 disc flexion [(1.41±0.09) kPa vs. (2.01±0.12) kPa, t=28.28], retroflexion [(1.54±0.07) kPa vs. (2.01±0.08) kPa, t=31.26], sidebend [(1.24±0.07) kPa vs. (1.89±0.13) kPa, t=31.13], rotated [(1.23±0.06)kPa vs. (1.85±0.11)kPa, t=34.99] were significantly lower than those in the control group ( P<0.01). Conclusion:The supine intermittent Angle traction combined with acupoint application in the treatment of cervical spondylotic radiculopathy can relieve the neck pain, improve the neck function, restore the physiological curvature of the cervical spine, and promote the recovery of cervical biomechanics.
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OBJECTIVE@#To compare the clinical efficacy on cervical spondylosis of nerve root type with qi stagnation and blood stasis treated with warming needle with different lengths of moxa stick.@*METHODS@#Six hundred patients with cervical spondylosis of nerve root type with qi stagnation and blood stasis were randomly divided into 4 groups: a 4 cm length group (150 cases, 5 cases dropped off, 2 cases suspended), a 3 cm length group (150 cases, 6 cases dropped off, 2 cases suspended), a 2 cm length group (150 cases, 6 cases dropped off), and a routine acupuncture group (150 cases, 6 cases dropped off). Warming needle with moxa stick in the length of 4 cm, 3 cm and 2 cm was delivered in the 4 cm length group, the 3 cm length group and the 2 cm length group, respectively. In the routine acupuncture group, simple acupuncture was applied. The acupoints selected in the above groups included Dazhui (GV 14) and bilateral Jiaji (EX-B 2) of C5 and C7, Fengchi (GB 20), Jianzhen (SI 9), Quchi (LI 11), Zhongzhu (TE 3), etc. In each group, the intervention was delivered once daily and 5 times a week. One course of intervention was composed of 2 weeks and 2 courses were required. The TCM syndrome score, the score of clinical assessment scale for cervical spondylosis (CASCS), the score of the brachial plexus traction test of the affected upper limb, F wave occurrence rate and conduction velocity of the ulnar nerve, the median nerve and the radial nerve of the affected upper limb were compared before and after treatment in the patients of each group. The levels of serum inflammatory factors, i.e. interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α) and hypersensitive C-reactive protein (hs-CRP), were measured before and after treatment in the patients of each group. The clinical cfficacy was evaluated in the 4 groups.@*RESULTS@#After treatment, the results of TCM syndrome evaluation, i.e. the scores of neck pain, activity limitation and upper limb numbness and pain, as well as the total scores; and the scores of brachial plexus traction test were reduced when compared with those before treatment in each group (P<0.01, P<0.05). The scores of subjective symptoms and adaptability, and the total scores of CASCS were elevated in comparison with those before treatment in each group (P<0.01, P<0.05). In the 4 cm length group, compared with the other 3 groups, the scores of neck pain and activity limitation for TCM syndrome evaluation, and its total score were lower (P<0.05, P<0.01); and the scores of subjective symptoms and adaptability, and the total score of CASCS were higher (P<0.05, P<0.01). The score of the brachial plexus traction test in the 4 cm length group was lower than that of the routine acupuncture group (P<0.05). After treatment, F wave occurrence rates and conduction velocity of median nerve and radial nerve were increased when compared with those before treatment in each group (P<0.05, P<0.01). F wave occurrence rate and conduction velocity of the radial nerve in the 4 cm length group were higher than those of the other 3 groups (P<0.05), and those of the median nerve were higher when compared with the routine acupuncture group (P<0.05). After treatment, the levels of serum IL-1β, IL-6 and TNF-α were all reduced when compared with those before treatment in each group (P<0.01, P<0.05); the level of serum IL-6 in the 4 cm length group was lower than those of the other 3 groups and serum level of TNF-α was lower compared with that in the routine acupuncture group (P<0.05). The total effective rate of the 4 cm length group was 78.3% (112/143), which was higher when compared with the 3 cm length group (67.6%, 96/142), the 2 cm length group (65.3%, 94/144) and the routine acupuncture group (53.5%, 77/144), respectively (P<0.05).@*CONCLUSION@#Warming needle with moxa stick of 4 cm in length effectively relieves the clinical symptoms of cervical spondylosis of nerve root type with qi stagnation and blood stasis, improves the nerve function of the upper limbs, and reduces the inflammatory responses caused by nerve compression. The clinical efficacy of this therapy with moxa stick of 4 cm in length is superior to the warming needle with moxa sticks of 3 cm and 2 cm, as well as the routine acupuncture.
Subject(s)
Humans , Interleukin-6 , Neck Pain , Qi , Tumor Necrosis Factor-alpha , Spondylosis/therapyABSTRACT
Objective:To compare the clinical features, X-ray, CT, MRI imaging findings of C 3, 4 single segment cervical spondylotic myelopathy among the elderly group, the middle-aged group and the young group. Methods:The medical records and imaging data of 51 cases of single segment C 3, 4 cervical spondylotic myelopathy treated from January 2017 to December 2021 were retrospectively reviewed. There were 10 cases in the young group, including 8 males and 2 females, 23-44 years, with an average age of 35.8±7.62 years; 14 cases in the middle-aged group, including 9 males and 5 females, 48-60 years, with an average age of 53.21±4.14 years; 27 cases in the elderly group, including 24 males and 3 females, 61-84 years, with an average age of 68.04±5.97 years. Based on the medical record data, the differences in clinical manifestations among the three groups (initial symptoms, symptom distribution, pathological sign distribution and JOA score) were analyzed. Based on the imaging data, the static factors (cervical osteophyte, alignment and thickness of cervical ligamentum flavum) and dynamic factors [overall cervical range of motion (ROM), individual segment cervical ROM, cervical instability and cervical nuchal ligament calcification] were analyzed. Anatomical factors (C 2-C 7 Cobb angle, C 4-C 7 Cobb angle, C 3 vertebral canal diameter, C 4 vertebral diameter, C 3 Pavlov ratio, C 4 Pavlov ratio) and spinal cord compression (spinal cord signal, compression position and compression nature) were also analyzed. Results:There were no statistically significant difference in gender distribution and height in three groups of patients ( P>0.05). In terms of clinical manifestations, there were statistically significant differences among the three groups in initial symptoms and chief symptoms ( P<0.05). The elderly group had upper limb weakness as the first symptom, lower limb weakness and abnormal gait as the chief complaint; the middle-aged group had upper limb numbness as the first symptom, upper limb numbness and weakness as the chief complaint; the young group had upper limb pain as the first symptom, upper limb numbness as the chief complaint. There were statistically significant differences in Hoffmann sign and Babinski sign among the three groups ( P<0.05). Hoffmann sign and Babinski sign were more common in the elderly group than in the young group ( P<0.05). There were significant differences among the three groups in total JOA score, JOA score of motor and lower limb motor JOA ( P<0.05). The total JOA score in the elderly group was lower than that in the young group ( P<0.05), especially for motor JOA score ( P<0.05), and lower limb motor JOA score ( P<0.05). There were no significant differences in first symptoms distribution, symptoms distribution, biceps reflex, triceps reflex, radial reflex or knee tendon reflex among the three groups ( P>0.05). In terms of static factors, there was significant difference in alignment and thickness of cervical ligamentum flavum among the three groups (P<0.05). The elderly group was more prone to slip than the young and middle aged groups ( P<0.05). The thickness of ligamentum flavum in the elderly group (2.18±0.68 mm) was thicker than that in the young group (1.60±0.30 mm) and the middle-elderly group (1.60±0.62 mm) ( P<0.05). There was no significant difference in cervical osteophyte among the three groups ( P>0.05). In terms of dynamic factors, there were statistically significant difference in C 3-C 7 ROM, C 4-C 7 ROM, C 3, 4 ROM and ossification of nuchal ligament among the three groups ( P<0.05). In the elderly group, C 3-C 7 ROM (22.18°) was larger than that in the young group (21.27°) ( P<0.05), while in the elderly group C 4-C 7 ROM (9.60°) was smaller than that in the young group (14.19°) ( P<0.05). In the elderly group, C 3, 4 ROM (15.30°) was larger than that in the young group (9.97°) ( P<0.05), and the elderly group was more prone to nuchal ligament calcification than the young and the middle-elderly group ( P<0.05). There were no significant difference among the three groups in C 4, 5 ROM, C 5, 6 ROM, C 6, 7 ROM or cervical instability ( P>0.05). For spinal cord compression, there were statistically significant differences among the three groups in the compression nature, compression location and MRI T2WI spinal cord signal ( P<0.05). The elderly group was more prone to anterior and posterior bony compression. The elderly group was more likely to show high signal intensity on spinal cord MRI T2WI than the young group ( P<0.05). For anatomical factors, there were statistically significant differences in C 2-C 7 Cobb, C 3 vertebral diameter and C 3 Pavolv among the three groups ( P<0.05) . The C 2-C 7 Cobb of the elderly group (21.06°) was larger than that of the young group (16.45°) ( P<0.05), and the C 3 diameter of the elderly group (9.61±0.33 mm) was smaller than that of the young group (10.38±1.19 mm) ( P<0.05). The C 3 Pavolv of the elderly group (0.52±0.03) was lower than that of the young group (0.59±0.11) ( P<0.05). In the presence of lordosis, C 4-C 7 Cobb in the elderly group (4.96°±4.05°) was smaller than that in the young group (12.42°±4.83°) and the middle-aged group (10.07°±6.14°) ( P<0.05). In the presence of kyphosis, C 4-C 7 Cobb in the elderly group (4.02°±1.19°) was larger than that in the young group (0.06°±0.01°) and the middle-aged group (1.83°±0.93°) ( P<0.05). There were no significant differences in C 3-C 7 Cobb, C 4 vertebral diameter or C 4 Pavolv among the three groups ( P>0.05). Conclusion:Young patients mostly have anteriorly soft compression of disc herniation, and most of them complain of neck and upper limb pain, while spinal cord compression and clinical manifestations are relatively mild. For the elderly patients, most of them have C 3 retrolisthesis, with the pinching type bony compression of spinal cord from both anteriorly and posteriorly, and their complaints are usually upper limb numbness, mostly accompanied by radiographically severe spinal cord compression and clinically gait abnormalities. In the middle-aged patients, the rigid compression of anterior calcified disc herniation is the main reason, and the numbness of upper limb is the chief complain.
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Objective:To investigate the clinical efficacy of full-endoscopic technique through the posterior cervical Delta large portal for the treatment of cervical spondylotic myelopathy and radiculopathy.Methods:The clinical data were analyzed retrospectively of the 15 patients who had been treated for cervical spondylotic myelopathy or radiculopathy at Orthopedics Department, Jiaxing Xiuzhou District People's Hospital from January 2020 to June 2021. There were 6 males and 9 females, aged from 54 to 76 years (average, 66.2 years). Responsible levels: 3 cases of C3, 4, 4 cases of C4, 5, 7 cases of C5, 6 and 1 case of C6, 7. They were all treated by full-endoscopic technique through the posterior cervical Delta large portal. The therapeutic efficacy was assessed by comparing the neck disability indexes (NDI) and Japanese Orthopaedic Association (JOA) cervical scores at preoperation, 1 and 3 months post-operation, and the last follow-up, and the modified MacNab scores at the last follow-up. The operative effects on cervical curvature and segmental stability were assessed by comparing the C2-7 cobb angles and operative ranges of motion (ROM) at preoperation, 1 and 3 months postoperation, and the last follow-up.Results:All cases completed their operation successfully. The operation time ranged from 56 to 82 min (average, 65.7 min), and the intraoperative blood loss from 10 to 30 mL (average, 20.7 mL). Tissue infection, intraspinal infection, dural tear, nerve root injury or perioperative anesthesia-related complications occurred in none of the patients. All patients were followed up for 6 to 18 months (average 10.8 months). The NDIs at 1 and 3 months post-operation, and the last follow-up (18.54%±3.06%, 14.96%±2.33%, and 12.89%±2.33%) were significantly lower than that before operation (34.19%±3.83%), and those at 3 months postoperation and the last follow-up significantly lower than that at 1 month postoperation ( P<0.05), but there was no significant difference between 3 months postoperation and the last follow-up in NDI ( P>0.05). The JOA scores at 1 and 3 months postoperation, and the last follow-up [(12.28±1.65), (13.30±1.57) and (13.54±1.41) points] were significantly higher than the preoperative value [(9.25±1.49) points] ( P<0.05), but there was no such a significant difference between postoperative time points ( P>0.05). Comparisons between preoperation, 1 and 3 months postoperation, and the last follow-up showed no significant difference in the C2-7 cobb angle or operative ROM ( P>0.05). The modified MacNab scores at the last follow-up resulted in 9 excellent, 5 good and 1 fair cases. Conclusion:In the treatment of cervical spondylotic myelopathy and radiculopathy, the full-endoscopic technique through the posterior cervical Delta large portal shows the advantages of limited invasion and complications, rapid recovery after operation, and little impact on the cervical curvature and segmental stability.
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The discs which are located in between the vertebras to act as shock absorbers during jolts to prevent spine injuries get either dislocated, bulged out or get thinned on continuous pressure being exerted upon them either by travel or a posture that is unsuitable to their alignment. In cases of discs getting thinned out and the height of these discs get reduced due to various causes produce undue pressure over the cervical spine resulting in oxidative stress and production of free radicals in the body causing deterioration of bone tissue and bone mass leading to regulation of RANKL/OPG ratio levels causing degeneration of bone. It is possible to resurrect the dehydrated discs with rehydration using Balamula (Sida cordifolia root) with the help of its properties and actions that it can positively act upon the area by refilling the gaps of erosions and assure a recovery with the proper administration of it in the form of ghee which has been processed with it and its intake being after food. Material & Methods: Various Ayurvedic classical textbooks and published journal articles were reviewed and analysed. Results: Evidences from various studies show that the phytochemicals obtain from Balamula (Sida cordifolia root) and Go- Ghritam (cow’s ghee) acts as antioxidant, reduces the activity of osteoclast and bone resorption by inhibiting RANKL receptor pathway. It also has anti-inflammatory, anti-arthritic, anti-analgesic effect that found to be effective in reducing the symptoms of cervical spondylosis.
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In the present era of modernization and fast life, everybody is over busy and living a very stressful life. Faulty dietetic habits and sedentary life style is responsible for early degenerative changes in bodily tissue. As per Ayurveda, Greevastambha has been described under Vataj Nanatmaja Vikaras. Few Lakshanas of Kupitoanilah such as Pani-Prishta-Shirograha, Gatrasuptata, Greevaya-Hundanama, Bhedastoda-arti are the well-known features of Greevastambha. Greevastambha can be correlated with Cervical Spondylosis of modern medical sciences. Cervical Spondylosis is a degenerative condition of cervical spine that affects the vertebral bodies and intervertebral disc of the neck as well as contents of the spinal canal. It leads to pain and stiffness in neck, radiating pain into arm, headache, vertigo, dizziness, paraesthesia, numbness etc. Material and Methods- Patients fulfilling the diagnostic and inclusion criteria were selected for the present study from the OPD/IPD of our institute. The present study was carried out in a single group of 10 patients. In the present study, Snehana Nasya along with Greevabasti with Karpasasthyadi Taila was taken to evaluate the combined effect in the management of Greevastambha w.s.r. to Cervical Spondylosis. Result- Statistically significant results were observed in the present study.
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Manyastambha is a type of Vataja Nanatmaja Vyadhi described under the heading of Vatavyadhi. It is characterized by symptoms like Ruk (pain) and Sthamba (stiffness) in the Manyapradesha (cervical region) of Urdwajatru Pradesha. Similar to this, there is a condition known as Cervical Spondylosis in western science based on symptomatology which is mainly due to the chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral discs of the neck as well as the contents of the spinal canal. The prevalence of cervical spondylosis is around 40% of the world population and may manifest in those as young as 30 years and most commonly in those aged between 40-60 years. Methodology: In the present study, a total of 30 patients were diagnosed with Manyastambha (Cervical Spondylosis). They were randomly assigned to a single group and have been treated by Rooksha Sweda (Valuka) and Bhringaraja Taila Nasya for 7 days with a follow-up of 14 days. Observations: It was observed in the present study that all subjective and objective parameters in all the 30 patients have shown significance with a p-value <0.01. Conclusion: Valuka Sweda and Nasya Karma are highly significant at P<0.001. Rooksha Sweda and Nasya Karma are the safest, simplest and most effective Panchakarma therapies in the management of Manyastambha (Cervical Spondylosis).
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The advent of civilization and overuse of life modifying gadgets like cell phones, computers, etc. leads to greater incidence of neck pain worldwide, of which Cervical spondylosis is the prime cause, which is a natural ageing process characterized by sequence of degenerative changes in the spinal structure. In Ayurveda, it can be closely correlated with Vishvachi, which is a Nanatmaja vatavyadhi, in which there is restriction of movement in arms associated with Ruk, Stambha, etc. features. Aims and Objectives: 1. To study etiopathogenesis, symptomatology, and progress of Vishvachi w.s.r. to cervical spondylosis. 2. To assess the efficacy of Dashamooladi taila nasya and Dashamooladi ghana vati individually and compare the effect of both schedules clinically. Materials and Methods: After proper identification, the selected raw herbs are used for Taila (oil) preparation according to Taila paka vidhi for Nasya and Kwatha was made for oral medication. The study was carried out in two parts- a). Literary- Textual references from various books, journal and papers on Internet were studied. b). Clinical- After considering the selection criteria, a total of 60 patients were treated in two groups- i) Group A: 30 patients were treated with Dashamooladi taila nasya for consecutive 21 days preceded by Abhyanga (oleation) & Svedana (fomentation). ii) Group B: 30 patients were treated with Dashamooladi Ghana vati consecutively for 21 days. Scoring was done on the basis of 09 parameters and statistical analysis was done. Result: Group A patients showed marked effect on Avamotana, Sanchari, Spandana, Aruchi & moderate effect on Ruk, Toda, Stambha & Tandra. Group B showed marked effect on Toda, Stambha, Spandana; and moderate effect on Ruk, Avamotana, Sanchar. Conclusion: Dashamooladi yoga (Dashamoola, Bala, Masha) is used both for shamana and Nasya medicine. These are effective in Vata-kaphaja ailments, Sotha, Shula, etc., and possess Balya, Brimhana, Rasayana, Vrishya etc., qualities.
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Objective:To explore the clinical effect of Guige Shujing Decoction combined with acupuncture in the treatment of cervical spondylotic radiculopathy with coldness-blood stasis obstructing meridians.Methods:A total of 86 patients with coldness-blood stasis obstructing meridians of cervical spondylotic radiculopathy, who met the inclusion criteria from May 2019 to May 2021, were divided into two groups, with 43 cases in each group, according to the random number table method. The control group was treated with routine basic treatment and acupuncture, and the observation group was treated with routine basic treatment, acupuncture and Guige Shujing Decoction. Both groups were treated for 4 weeks and followed up for 6 months. The scores of TCM syndromes were performed before and after treatment, Clinical Assessment Scale for Cervical Spondylosis (CASCS) was used to evaluate cervical spine function, Visual Analogue Score (VAS) was used to evaluate the degree of pain, Neck Disability Index (NDI) was used to evaluate cervical spine function, and ELISA was used to detect levels of hypersensitive C-reactive protein (hs-CRP), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α). The adverse reactions were observed during treatment and the recurrence rate was recorded during follow-up.Results:The total effective rate of the observation group was 95.35% (41/43), and that of the control group was 81.40% (35/43), the difference between the two groups was statistically significant ( χ2=4.07, P=0.043). After treatment, the scores and total scores of shoulder and neck pain, upper limb numbness, neck stiffness, head tenderness and heaviness in the observation group were significantly lower than those in the control group ( t values were 10.66, 12.89, 9.12, 12.27 and 8.75, respectively, P<0.001). After treatment, the CASCS score in the observation group was significantly higher than that of the control group ( t=2.64, P=0.010). After treatment, the VAS and NDI scores in the observation group were significantly lower than those in the control group ( t values were 5.62 and 7.00, respectively, P<0.001). After treatment, the levels of serum hs-CRP, IL-1β and TNF-α in the observation group were significantly lower than those in the control group ( t values were 6.65, 7.52 and 5.08, respectively, P<0.001). There was no significant difference in the incidence of adverse reactions between the two groups during treatment ( χ2=0.73, P=0.393). After 6 months of follow-up, the recurrence rate in the observation group was 2.44% (1/41) and that in the control group was 17.14% (6/35). There was a statistically significant difference in the recurrence rate between the two groups ( χ2=3.89, P=0.048). Conclusion:The Guige Shujing Decoction combined with acupuncture therapy can inhibit the neurogenic inflammatory reaction of patients with coldness-blood stasis obstructing meridians of cervical spondylotic radiculopathy, reduce pain, improve cervical spine function, reduce recurrence rate and improve curative effect.
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Objective:To study the medication rules of treating cervical spondylosis by National TCM master Liu Bailing based on data mining and network pharmacology, and explore the potential action mechanism of its core compounds.Methods:By collecting the prescriptions of National TCM master Liu Bailing treating cervical spondylosis in the past 8 years, this paper analyses the frequency, nature, flavor, meridian, hierarchical clustering and association rules of those prescriptions by RStudio to obtain the core prescription. Then, the effective components of the core prescription were collected by using TCMSP, and the network of "medicine-component-target" was constructed by using Cytoscape 3.8.0; by searching for databases like GEO, DisGeNET, TTD HPO and Genecards were retrieved to obtain the target data set of cervical spondylosis; by using STRING 11.0 platform to construct protein interaction network; by using DAVID platform to cary out gene ontology (GO) and KEGG pathway enrichment analysis; by using Auto Dock software for molecular docking.Results:In the 844 prescriptions, there are 199 Chinese medicines and the properties are mainly warm, plain and cold; the flavors were mainly sweet, pungent and bitter; mainly belong to the liver, spleen, and kidney meridians. The Association Rule shows that the core compound is made up of Salvia miltiorrhiza, Gastrodia elata, Rhizoma corydalis, Alisma rhizoma, centipede, Astragalus membranaceus and Rhizome of Pueraria. Besides, 140 effective constituents and 247 targets of the core prescription were screened, and the main constituents were quercetin, kamanol, luteolin, tanshinone ⅡA, β-sitosterol, etc. 13 core targets among the core prescription treating cervical spondylosis were obtained, which were enriched into 30 pathways including toll-like receptor signaling pathway, TNF signaling pathway and HIF-1 signaling pathway. Conclusion:National TCM master Liu Bailing treatment of cervical spondylosis mainly focuses on expelling wind and relieving pain, dredging meridians and soothing tendons, and the mechanism of action of the core prescription may focus on inhibiting inflammatory response and relieving oxidative stress, providing guidance and reference for the clinical treatment of cervical spondylosis.
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ObjectiveTo explore the effect of Suanzaoren Tang combined with Ziwu Liuzhu acupuncture on the vertebral artery hemodynamics， inflammatory cytokines， and neurotrophic factors in the patients with cervical insomnia with syndrome of deficiency of both heart and spleen. MethodThe random number table method was employed to assign 164 patients with cervical insomnia with syndrome of deficiency of both heart and spleen treated in the First Clinical Medical School of Guangzhou University of Chinese Medicine from January 2018 to June 2021 into a control group and an observation group. The control group was orally administrated with 1-2 mg estazolam tablets before bed for 4 weeks， and the observation group with Suanzaoren Tang combined with Ziwu Liuzhu acupuncture for 4 weeks. The therapeutic efficacy and safety were observed. The Pittsburgh Sleep Quality Index （PSQI） score， polysomnography monitoring results， hemodynamics parameters of vertebral artery， and serum levels of inflammatory cytokines and neurotrophic factors were compared before and after treatment. ResultExcept 4 dropouts， the remaining 160 patients were included in this study， with 80 patients in each group. The observation group had higher total effective rate than the control group ［92.50% （74/80） vs. 80.00% （64/80）， χ2=5.270， P<0.05］. Compared with that before treatment， the therapies in both groups decreased the PSQI score， sleep latency time， awakening time， awakening times， serum levels of interleukin-1β （IL-1β）， C-reactive protein （CRP）， and tumor necrosis factor-α （TNF-α） （P<0.01）. Meanwhile， they increased the proportion of rapid-eye-movement （REM） sleep， the diastolic blood flow velocity （Vd）， systolic blood flow velocity （Vs）， and mean blood flow velocity （MFV） of vertebral artery， as well as the serum levels of brain-derived neurotrophic factor （BDNF） and glial cell-derived neurotrophic factor （GDNF） （P<0.05， P<0.01）. Moreover， the observation group had lower PSQI score， sleep latency time， awakening time， awakening times， and serum IL-1β， CRP， and TNF-α levels （P<0.01） and higher proportion of REM sleep， Vd， Vs， MFV of vertebral artery， and serum BDNF and GDNF levels （P<0.05， P<0.01） than the control group. ConclusionZiwu Liuzhu acupuncture combined with Suanzaoren Tang can improve blood circulation of vertebral artery， reduce the serum levels of inflammatory cytokine， and increase the serum levels of neurotrophic factors to improve the sleep quality of the patients with cervical insomnia with syndrome of deficiency of both heart and spleen.
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ObjectiveTo explore the effect of Suanzaoren Tang combined with Ziwu Liuzhu acupuncture on the vertebral artery hemodynamics， inflammatory cytokines， and neurotrophic factors in the patients with cervical insomnia with syndrome of deficiency of both heart and spleen. MethodThe random number table method was employed to assign 164 patients with cervical insomnia with syndrome of deficiency of both heart and spleen treated in the First Clinical Medical School of Guangzhou University of Chinese Medicine from January 2018 to June 2021 into a control group and an observation group. The control group was orally administrated with 1-2 mg estazolam tablets before bed for 4 weeks， and the observation group with Suanzaoren Tang combined with Ziwu Liuzhu acupuncture for 4 weeks. The therapeutic efficacy and safety were observed. The Pittsburgh Sleep Quality Index （PSQI） score， polysomnography monitoring results， hemodynamics parameters of vertebral artery， and serum levels of inflammatory cytokines and neurotrophic factors were compared before and after treatment. ResultExcept 4 dropouts， the remaining 160 patients were included in this study， with 80 patients in each group. The observation group had higher total effective rate than the control group ［92.50% （74/80） vs. 80.00% （64/80）， χ2=5.270， P<0.05］. Compared with that before treatment， the therapies in both groups decreased the PSQI score， sleep latency time， awakening time， awakening times， serum levels of interleukin-1β （IL-1β）， C-reactive protein （CRP）， and tumor necrosis factor-α （TNF-α） （P<0.01）. Meanwhile， they increased the proportion of rapid-eye-movement （REM） sleep， the diastolic blood flow velocity （Vd）， systolic blood flow velocity （Vs）， and mean blood flow velocity （MFV） of vertebral artery， as well as the serum levels of brain-derived neurotrophic factor （BDNF） and glial cell-derived neurotrophic factor （GDNF） （P<0.05， P<0.01）. Moreover， the observation group had lower PSQI score， sleep latency time， awakening time， awakening times， and serum IL-1β， CRP， and TNF-α levels （P<0.01） and higher proportion of REM sleep， Vd， Vs， MFV of vertebral artery， and serum BDNF and GDNF levels （P<0.05， P<0.01） than the control group. ConclusionZiwu Liuzhu acupuncture combined with Suanzaoren Tang can improve blood circulation of vertebral artery， reduce the serum levels of inflammatory cytokine， and increase the serum levels of neurotrophic factors to improve the sleep quality of the patients with cervical insomnia with syndrome of deficiency of both heart and spleen.
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@#Objective To observe the effect sling exercise therapy (SET) and Tuina on radicular cervical spondylosis. Methods From August, 2015 to December, 2016, 72 patients with radicular cervical spondylosis were randomly divided into control group (n = 36) and trial group (n = 36), who accepted traction and SET+Tuina, respectively, for four weeks. They were measured F-wave conduction velocity with electromyogram from median nerve and ulnar nerve, somatosensory evoked potential (SEP), and current perception threshold (CPT) before and after treatment. The clinical ratio of improvement was calculated. Results The ratio of improvement was 83.33% in the trial group more than 58.33% in the control group (Z = 2.093, P < 0.05). F-wave conduction velocity increased in both groups after treatment (t > 12.059, P < 0.001), and increased more in the trial group than in the control group (t > 3.266, P < 0.01); while the latency of SEP decreased in N9 and N13 in both groups (t > 7.061, P < 0.001), and decreased more in the trial group than in the control group (t > 8.033, P < 0.001); the grade of CPT decreased in both groups (t > 8.895, P < 0.001), and decreased more in the trial group than in the control group (t = 8.913, P < 0.001). Conclusion The combination of SET and Tuina can promote the repair of nerve conduction of cervical spondylotic radiculopathy.
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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.
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Child , Child, Preschool , Female , Humans , Male , Cervical Vertebrae/surgery , Decompression/adverse effects , Musculoskeletal Manipulations , Radiculopathy/surgery , Retrospective Studies , Spondylosis/surgery , Treatment OutcomeABSTRACT
bjective To observe the changes of upper extremity sensory function in patients with radicular cervical spondylosis and evaluate the treatment effect, by using the method of suspension exercise therapy (SET) and soft tissue manipulation. Methods A total of 72 patients with cervical spondylosis were divided into observation group (treated by SET combined with manipulation)and control group (treated by purely cervical traction) by simple random method. Both groups received 4-week continuous treatment for 6 times per week. The somatosensory evoked potential(SEP), current perception threshold (CPT) before and after the treatment in two groups were separatedly tested, and changes in visual analogue scale (VAS) pain scores of the affected limbs were examined, so as to determine the effective rate of treatment. Results After treatment, the latency of SEP was shortened mainly in brachial plexus potential N9 and cervical spinal potential N13 in two groups (P<0.05). The CPT levels and the VAS pain scores of the affected limbs were reduced in two groups (P<0.01), and the treatment effect in observation group was better that in control group (P<0.01)．Conclusion SET combined with soft tissue manipulation can effectively promote the repair of nerve sense function of cervical spondylotic radiculopathy.
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Objective: To observe the clinical efficacy of warm needling moxibustion plus spine subtle adjusting manipulation for cervical radiculopathy. Methods: A total of 70 patients with cervical radiculopathy were randomized into an observation group and a control group, with 35 cases in each group. The observation group was treated with warm needling moxibustion plus spine subtle adjusting manipulation, while the control group was treated with warm needling moxibustion alone. The treatments were performed three times a week, and for four weeks in total. The visual analog scale (VAS) was scored before and after treatment. And the clinical efficacy of the two groups was compared after treatment. Results: The total effective rate was 97.1％ in the observation group, versus 88.6％ in the control group. The difference between the two groups was statistically significant (P<0.05). After treatment, the VAS scores in both groups significantly decreased (P<0.01), and the score in the observation group was significantly lower than that in the control group (P<0.05). Conclusion: Warm needling moxibustion plus spine subtle adjusting manipulation has a better effect in the treatment of cervical radiculopathy than warm needling moxibustion alone.
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Acupuncture has achieved good effect in the treatment of various types of cervical spondylosis, which can alleviate the symptoms of neck pain and vertigo, and improve the blood supply to the brain. In terms of acupuncture location, treatment mainly selects acupoints according to meridians and syndrome differentiation, that is, identifying the diseased meridians and giving acupuncture treatment according to massage along meridians and pressing in the traditional meridian diagnosis method,or taking points according to location, including near and far ends based on meridian theory, acupuncture needlingcorresponding locations of hands and feet based on holographic theory, or taking points according to innervated areas or muscle fibers based on anatomical structure. Acupuncture methods mainly include warming and dredging acupuncture, short needling, fast needling and so on. In addition to filiform needles, floating needles, long needles, electroacupuncture and other special needles arealso usedin clinic.
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OBJECTIVE@#To study the changes of anterior soft tissue swelling after anterior cervical subtotal corpectomy, titanium mesh fusion and internal fixation.@*METHODS@#From November 2015 to July 2018, 151 patients with cervical spondylotic myelopathy were treated with anterior single corpectomy, titanium mesh fusion and internal fixation, including 109 males and 42 females, aged 44 to 81 (59.77±8.34) years. Through postoperative follow up observation, the C@*RESULTS@#All patients were followed up for 15 to 40(28.00±3.52) months. One week after the operation, the swelling of anterior soft tissue reached the peak, and then decreased. At 8 months after the operation, the swelling of anterior soft tissue on C@*CONCLUSION@#Anterior subtotal cervical corpectomy, titanium mesh bone graft fusion and internal fixation can cause swelling of the anterior soft tissue. One week after operation, we should pay more attention to the aggravation of the swelling of the anterior soft tissue to avoid the occurrence of dysphagia, respiratory obstruction, asphyxia and other complications.
Subject(s)
Female , Humans , Male , Cervical Vertebrae/surgery , Retrospective Studies , Spinal Cord Diseases , Spinal Fusion , Spondylosis , Treatment OutcomeABSTRACT
OBJECTIVE@#To observe the changes of functional connectivity of brain pain-emotion regulation region in patients with cervical spondylosis of cervical type by functional magnetic resonance imaging (fMRI).@*METHODS@#Thirty-two subjects were selected. Of them, 16 patients with cervical spondylosis of cervical type were divided into an observation group and 16 healthy subjects into a control group. The patients in the observation group were treated with acupuncture at Tianzhu (BL 10), Jingbailao (EX-HN 15), Jianzhongshu (SI 15) and @*RESULTS@#In the observation group, the VAS score was (1.94±1.12) after the treatment, which was lower than (5.62±1.20) before treatment (@*CONCLUSION@#Pain involves the formation and expression of "pain-emotion-cognition". Acupuncture can systematically regulate the brain functional connections between cognitive regions such as dorsal prefrontal lobe and anterior cingulate gyrus and emotional regions such as insula and VTA in patients with cervical spondylosis of cervical type, suggesting that acupuncture has a multi-dimensional and comprehensive regulation effect on pain.
Subject(s)
Humans , Acupuncture Therapy , Brain/diagnostic imaging , Emotions , Magnetic Resonance Imaging , Pain , Spondylosis/therapyABSTRACT
OBJECTIVE@#To investigate the clinical efficacy of zero-profile anchored spacer (ROI-C) in treating cervical spondylosis with osteoporosis.@*METHODS@#From May 2013 to May 2018, a total of 145 patients with cervical spondylosis were treated by ROI-C through anterior cervical spine approach. Among them, 31 patients were aged ≥60 years and had osteoporosis by bone density measurement, and they were retrospectively analyzed. Including 9 males and 22 females, aged 60-84 years old with an average of (69.12±7.65) years. There were 23 cases of single-segment fusion, 6 cases of two-stage fusion, and 2 cases of three-stage fusion;and 41 devices of ROI-C fusion was placed in the patients. Operation time and intraoperative blood loss were recorded;Japanese Orthopaedic Association (JOA) scores and visual analogue scale(VAS) were respectively used to evaluate the neurological function and neck pain before and after operation. The cervical curvature (expressed as Cobb angle), the height of the intervertebral space at the surgical segment, and the intervertebral fusion were observed at postoperative and follow-up periods were observed by image data.@*RESULTS@#All patients were followed up for 12-24(15.6±4.4) months after operation. The operation time were from 75 to 113 (101.33±10.25) min and intraoperative blood loss were from 14 to 51 (33.18 ± 16.56) ml. Among these 23 patients with fusion of single segment, the operation time were 75 to 98 (85.47±8.70) min and intraoperative blood loss were 14 to 30(21.18±6.56) ml. JOA scores of all included patients were increased from 9.66±2.12 preoperatively to 14.36±1.24 at the final follow-up (@*CONCLUSION@#Anterior cervical approach with ROI-C for the treatment of elderly patients with cervical spondylosis and osteoporosis had reliable clinical effect, short operation time, less intraoperative blood loss, and can effectively restore cervical curvature and intervertebral space height, and has advantages of fewer complications and higher successful rate of fusion.