Clinical observation on acupuncture plus chiropractic treatment for cervical spondylosis

Wei Wen-guang (魏文廣), Dong Cheng-wei (董成偉), Hu Wei-cheng (胡衛(wèi)成), Lu Zhong (陸忠)

1 The First People’s Hospital of Changzhou, Jiangsu 213003, China

2 Changzhou Traditional Chinese Medicine Hospital, Jiangsu 213000, China

Clinical Study

Clinical observation on acupuncture plus chiropractic treatment for cervical spondylosis

Wei Wen-guang (魏文廣)1, Dong Cheng-wei (董成偉)2, Hu Wei-cheng (胡衛(wèi)成)2, Lu Zhong (陸忠)1

1 The First People’s Hospital of Changzhou, Jiangsu 213003, China

2 Changzhou Traditional Chinese Medicine Hospital, Jiangsu 213000, China

Objective:To observe the therapeutic effect of Governor Vessel-unblocking and yang-regulating acupuncture plus chiropractic treatment on upper cervical spondylosis.

Acupuncture Therapy; Tuina; Massage; Chiropractic; Atlanto-axial Joint; Lumbar Vertebrae; Cervical Spondylosis

Generally, C1(atlas) and C2(axis) make up the upper cervical spine. Since it’s complicated in structure and close to the brain, it’s challenging to treat problems in this area. Considering the high risk, surgery is not the first option. Instead, most patients receive comprehensive conservative therapy.

We will focus on upper cervical spondylosis due to structural change in vertebrae, which falls under the category of ‘bone subluxation’ in traditional Chinese medicine (TCM). We’ve treated this condition by Governor Vessel-unblocking and yang-regulating needling method, fine adjustment of the upper cervical spine and lumbosacral Ban-pulling manipulation. The results are now summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

In conformity with the diagnostic criteria of cervical spondylosis in theGuidelines on Diagnosis, Treatment and Rehabilitation of Cervical Spondylosispublished in 2010 by professional board for cervical spondylosis of China Association of Rehabilitation Medicine[1], including spinous process deviation of the axis, asymmetry of the atlantoaxial joint space or broadening of the atlantoodontoid interval in imaging study; abnormality of the upper cervical spine by palpation; and typical clinical manifestations of the upper cervical spondylosis, such as occipital pain, and vertigo.

1.2 Inclusion criteria

Those in conformity with the above diagnostic criteria; aged between 20 and 65, and duration ≥ one year; understanding the situation of this study and willing to sign the informed consent.

1.3 Exclusion criteria[2]

Those with serious internal or mental disorders; those with non-spinal neck diseases; those with developmental abnormality or bone destruction of the cervical vertebrae, and those with acute traumatic injury of the cervical vertebrae.

1.4 Statistical methods

The data were processed by SPSS 13.0 software for statistical analysis. The measurement data were expressed by mean ± standard deviationThe independent samplet-test was applied. Chi-square test was used for comparison of the enumeration data. APvalue ＜0.05 was used to indicate the difference of statistical significance.

1.5 General data

The patients came from the Acupuncture Department of the First People’s Hospital of Changzhou and Tuina Clinic of Changzhou Traditional Chinese Medicine Hospital between January of 2013 and January of 2015, and were randomly divided into an observation group and a control group by the random digital table, 32 cases in each group. The general data were not statistical differences between the two groups (P＞0.05), in better homogeneity (Table 1).

Table 1. Comparison of general data between the two groups

2 Therapeutic Methods

2.1 Observation group

2.1.1 Acupuncture to dredge the Governor Vessel and regulate yang

Major acupoints: Baihui (GV 20), Fengchi (GB 20), Fengfu (GV 16), Dazhui (GV 14), Houxi (SI 3), Yaoyangguan (GV 3) and Guanyuanshu (BL 26).

Adjunct acupoints: Qihaishu (BL 24) was added for serious low back pain; Zusanli (ST 36) for qi deficiency; Geshu (BL 17) for blood deficiency; Taichong (LR 3) for hyperactivity of liver yang; Xuehai (SP 10) for blood stasis; and Fenglong (ST 40) for phlegm and dampness.

Method: The patient took a prone position. The filiform needles of 0.25 mm in diameter and 40 mm in length were selected. After the skin of the acupoint areas was disinfected routinely, the needle was inserted from Fengchi (GB 20) toward Fengfu (GV 16). After the arrival of the needling sensation, the needle was manipulated by moderate needling technique. The needles were retained for 30 min and manipulated once every 10 min. The treatment was given once every day, for ten sessions continuously.

2.1.2 Spinal adjustment

After acupuncture, the manual techniques were combined to reposition the atlantoaxial vertebrae and lumbosacral vertebrae. Before the manual techniques, it was necessary to massage the local areas to relax the muscles. The reduction technique was used after the first treatment. Afterward, in the manual palpation to touch the spine at the fifth and tenth treatment, the reduction technique was used again to set the spine, if the abnormality was palpated.

The fine adjustment technique for the upper neck section, proposed by Prof. Shen Guo-quan, was applied to reposition the atlantoaxial vertebra[3]. After the patient took a lateral recumbent position, with the spinous process of C1upward, the practitioner stood behind the patient and pushed the lateral side of the patient’s transverse process of the dislocated atlantoaxial vertebrae downward with the thumb, and upheld the patient’s opposite temple with the other palm. The practitioner slowly flexed the patient’s head with the palm passively for about 15°, in sensing the patient’s muscles were relaxed, and suddenly enlarged the lateral flexion of the patient’s head by an amplitude of 3-5° with coordination of the practitioner’s technique, and at the same time pushed the transverse process of the protruding atlantoaxial vertebra with the thumb. After the operation, the reposition was confirmed by palpation (Figure 1).

Figure 1. Reposition technique of atlantoaxial vertebrae

The lateral Ban-pulling technique for repositioning the lumbosacral vertebrae, proposed by Prof. Wei Yi-zong, was applied to reposition the lumbosacral vertebrae[4]. After the patient took a lateral recumbent position, with the above lower limb on the flexed hip joint, the practitioner stood facing to the patient and held the upper part of the patient’s anterior armpit with one hand, and put the ular side of the flexed elbow of the other hand near the sacroiliac joint of the patient’ship, to make a small amplitude to shake the lumbosacral region, and released the strength in opposite direction instantly and simultaneously by the two hands when sensing the patient’s muscles were relaxed, for forming a shear force at the lumbosacral joint. After the operation, the reposition was confirmed by palpation (Figure 2).

Figure 2. Reposition technique for lumbosacral vertebrae

2.2 Control group

2.2.1 Routine acupuncture

Major acupoints: Baihui (GV 20), Fengchi (GB 20), C4-7Jiaji (EX-B 2), Houxi (SI 3)[5].

Adjunct acupoints: Similar to the observation group.

Method: The patient took the prone position. The filiform needles of 0.25 mm in diameter and 40 mm in length were selected. After the skin of the acupoint areas was disinfected routinely, the needle was inserted from Fengchi (GB 20) toward the nose tip. After the arrival of the needling sensation, the needle was manipulated by moderate needling technique. The needles were retained for 30 min and manipulated once every 10 min. The treatment was given once every day, for ten sessions continuously.

2.2.2 Chiropractic

The patients in the control group were treated with the same chiropractic therapy as those in the observation group. The manual techniques and treating hours were similar to those in the observation group.

3 Observation of Therapeutic Effects

3.1 Criteria of therapeutic effects

In the process of this study, no case dropped off. The criteria of the therapeutic effects in this study were stipulated in reference to the relevant literature[2].

Cure: The symptoms and signs disappeared, with normal X-ray film of the atlantoaxial joint.

Remarkable effect: The symptoms and signs disappeared basically, with tendency of normal X-ray film of the atlantoaxial joint.

Improvement: The symptoms and signs were relieved, or with presence of change in X-ray film of the dislocated atlantoaxial joint.

Failure: No change in the symptoms and signs and X-ray film.

3.2 Results

After 10 treatments, the total effective rate was 78.1% in the observation group and 62.5% in the control group. The difference in the total effective rate between the two groups were statistically significant (P＜0.05), (Table 2).

Table 2. Comparison of therapeutic effects between two groups (case)

4 Discussion

4.1 Relationship between problems of the atlantoaxial and lumbosacral vertebrae[4,6]

The relationship between atlantoaxial and lumbosacral vertebrae is mainly manifested in the biomechanics of the spine. Prof. Wei Yi-zong believes in his ‘Theory on Four-dimensional Equilibrium of Spinal Contour Stress’ that stress imbalance caused by the subluxated lumbosacral vertebrae may affect the atlantoaxial vertebrae. Both the atlantoaxial vertebrae and lumbosacral vertebrae are pivots of the spine. The important relationship of stress equilibrium exists between them, i.e. ‘towel-twisting’ effect on the top and end of the spine. In order to maintain a balance of the skull in standing position, the combined force produced by functioning on the muscles of ‘the craniovertebral axial joint’ (joint between the skull and cervical vertebra) at the level surface must be identical to ‘the lumbosacral axial joint’ (adjacent joint of the lumbar vertebra and sacral vertebra) in direction and volume. Once lumbosacral problems lead to stress change, the passive migration will take place in the upper cervical vertebrae in order to adapt to the new balance. The static balance between the skull base and upper cervical spine is mainly accomplished by thesuboccipital muscles[7](obliques capitis inferior, obliques capitis superior, rectus capitis posterior major, rectus capitis posterior minor). Therefore, the change of combined force will cause traction on the atlantoaxial vertebrae in the horizontal direction, so as to induce dislocation or migration. Clinically, chiropractic therapy is emphasized to maintain a holistic stress balance of the spine. In the repositioning technique for the upper cervical vertebrae, not only the local adjustment should be emphasized, but also the joints and muscles of the lumbosacral region must be paid attention to. In the 64 patients in this study, there were 40 cases with the subjective lumbosacral discomfort by inquiry, 45 cases with local tenderness by palpation, and 56 cases with abnormal position and structure of the lumbosacral vertebrae by physical inspection.

4.2 Relationship between problems of the atlantoaxial vertebra and function of the Governor Vessel[7-9]

In the traditional theory of meridians, the spine is closely related to the functions of the Governor Vessel and Foot Taiyang Meridian, the Governor Vessel in particular. The occipital region of the atlantoaxial vertebra is where the Governor Vessel and Foot Taiyang Meridian go through. Fengfu (GV 16), Yamen (GV 15), Tianzhu (BL 10) and Fengchi (GB 20) are the main crossroads for the meridians to enter the brain and are easily infected by pathogenic wind and cold. In terms of pathogenesis in Chinese medicine, this disease is caused by obliquity of the vertebrae, leading to obstruction in the Governor Vessel and then pain. When the Governor Vessel is obstructed, yang qi will be blocked and fail to ascend to the brain, inducing to headache, vertigo and blurred vision. Clinically, the anatomical structure of the atlantoaxial vertebrae is extremely complicated. The cervical spondylosis in this section is mostly caused by the involvement of the vertebral artery, greater occipital nerve, and minor occipital nerve, manifested by dizziness, vertigo, headache, and migraine. The feature of those manifestations can be mutually supplemented by analysis of pathogenesis and clinical symptoms in Chinese medicine. It can be seen that the morbidity of the atlantoaxial vertebrae is related to the obstruction of qi dynamics in the Governor Vessel and failure of the clear yang to enter the brain, resulting in various problems of the neck.

4.3 Significance to unblock the Governor Vessel by acupuncture plus spinal adjustment[3,10]

Upper cervical spondylosis is surely related to the Governor Vessel. The pathological position could be upper or lower. The treatment should be given to dredge the Governor Vessel and regulate the vertebral bones predominantly. As soon as the Governor Vessel is unblocked, qi and blood can flow smoothly, and the clear yang can ascend and all symptoms will be eliminated. Therapeutically, the upper and lower chiropractic techniques are used respectively to correct the local dislocation of the atlantoaxial vertebrae and adjust the holistic stress of the spine, and eliminate the environment of physical compress in the peripheral tissues of the spine, so as to realize the goal of ‘upright bone and soft tendon’. Acupuncture is used to dredge qi of the Governor Vessel and regulate local qi and blood. Fengchi (GB 20) and Fengfu (GV 16) are used to dredge and regulate the local qi and blood. Dazhui (GV 14), a confluent acupoint of the three yang meridians and Governor Vessel, is used to dredge the Governor Vessel, regulate yang and correspond to the sacral vertebrae. Yaoyangguan (GV 3) is able to regulate the local sacral vertebrae and ascend qi of the Governor Vessel. Houxi (SI 3) links with the Governor Vessel via the Hand Taiyang Meridian and is used as an important distal acupoint for cervical spondylosis. By combination of the acupoints in the upper body and lower body, acupuncture and chiropractic therapy are used simultaneously to set the bone, dredge the Governor Vessel, regulate yang and ascend the clear.

4.4 Reconsideration of acupuncture treatment for cervical spondylosis in the upper neck

It is not difficult to find out by considering the relationship between the atlantoaxial vertebrae and lumbosacral vertebrae and the relationship between the Governor Vessel and spine: bone dislocation of the atlantoaxial vertebra takes place and causes blockage in the Governor Vessel. This condition also occurs in the lumbosacral vertebrae. Either pain, tenderness or dislocation in the lumbosacral vertebrae can indicate the blockage of the Governor Vessel in the local area. Therefore, in acupuncture treatment of upper cervical spondylosis, it is necessary to emphasize the local dredging action and also select the acupoints in the area of the lumbsacral region, in order to give a treatment by upper acupoints and lower acupoints, and dredge and regulate the Governor Vessel. In the clinical practice, the selection of the acupoints from the upper pathway and lower pathway of the Governor Vessel and the simultaneous treatment of the atlantoaxial vertebrae and lumbosacral vertebrae are theoretically supplemented. Both of them contain the holistic viewpoints of Chinese medicine and are of high clinical guiding value in the practical consultation and treatment. We believe that the comprehensive explanation of the mutual relationship between the Governor Vessel and spine from the angle of integrated Chinese and Western medicine is extremely significant and needs further study.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Received: 15 March 2015/Accepted: 23 April 2015

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Translator: Huang Guo-qi (黃國琪)

針刺結(jié)合整脊療法治療頸椎病臨床觀察

目的：觀察通督調(diào)陽針刺結(jié)合整脊療法治療上段頸椎病的療效。方法：將符合納入標(biāo)準(zhǔn)的64例患者按隨機(jī)數(shù)字表法隨機(jī)分觀察組和對照組, 每組32例。觀察組采用通督調(diào)陽針刺結(jié)合上頸段微調(diào)法和腰骶側(cè)扳法整脊手法治療; 對照組采用常規(guī)針刺及與觀察組相同的整脊治療。兩組均每日治療1次, 連續(xù)治療10次后觀察療效。結(jié)果：觀察組總有效率為78.1%, 對照組為67.5%, 兩組總有效率差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論：通督調(diào)陽針刺結(jié)合整脊療法治療上段頸椎病療效優(yōu)于常規(guī)針刺結(jié)合整脊療法。

針刺療法; 推拿; 按摩; 整脊療法; 寰樞關(guān)節(jié); 腰椎; 頸椎病

R246.2 【

】A

Author: Wei Wen-guang, attending physician of traditional Chinese Medicine

Lu Zhong, vice chief physician of traditional Chinese medicine.

E-mail: 119436259@qq.com

Methods:A total of 64 eligible cases were randomly allocated into an observation group (n=32) and a control group (n=32) according to the random digital table. Cases in the observation group were treated with Governor Vessel-unblocking and Yang-regulating needling method, fine adjustment of the upper cervical spine and lumbosacral Ban-pulling manipulation; cases in the control group were treated with routine acupuncture and same spinal adjustment as the observation group. The treatment was done once a day in both groups. The therapeutic efficacies were observed after 10 times of treatment.

Results:The total effective rate was 78.1% in the observation group and 67.5% in the control group. The difference in the total effective rate between the two groups was statistically significant (P＜0.05).

Conclusion:Governor Vessel-unblocking and yang-regulating acupuncture and regulate yang plus chiropractic therapy is better than routine acupuncture plus chiropractic therapy in the therapeutic effect in the treatment of upper cervical spondylosis.