"CERVICAL SPONDYLOSIS : TREATMENT WITH ACUPUNCTURE"

ABSTRACT

Therapeutic effect of Acupuncture was studied on 90 cases of Cervical Spondylosis at Indian Acupuncture Research and training Centre, Raipur, INDIA from June 1975 to December 1979. Excellent results were seen in 70% cases, good results in 20% cases and poor response in 10% cases. 90% cases showed remarkably improvement in the neck movements along with significant relief of pain for a long duration. Follow up studies showed that in 20% cases there was recurrence of symtoms like pain and stiffness of the neck, though not of original severity. These could be controlled with minium number of sittings, The detailes of this treatment will be discussed in the paper.

INTRODUCTION

Cervical Spondylosis is a condition characterised by progressive degeneration of cervical speine. The changes begin in the intervertebral disc and gradually involve the posterior intervertebral joints. These degenerative changes is joints are associated with long changes in the form of osteo phyte formation. these changes cause compression of the spinal nerves, spinal blood vessels and accasionally spinal cord.

Cervical spondylosis is an ageing process. This process is hastened by chronic stress and strain involving the cervical spine, e.g. lifting weight on the head.

In spite of the presense of spondylosis the patient may be asymptomatic & the condition dected only by radigraphy. The symptoms may be intermittant when present they are mostly due to compression of spinal nerves resulting in radicular pain, stiffness, muscular wasting, weakness and loss of deap reflexes. Rarely, symptoms of cranial nerve palsy or paraparesis may arise due to vertebro basilar insufficiency or spinal cord compression.
In spite of universal accurance of the condition, there is no satisfactory method of treatment. Drugs, traction and physiotherapy are unable to provide a lasting relief. In view of this fact, we intended to study the role of acupuncture therapy in this extremely common condition.

MATERIAL AND METHODS

The Material for the present study consisted of 90 cases of cervical spondylosis seen at Indian Acupuncture Research and Training Centre, Raipur, INDIA from June 1975 to December 1979. The diagnosis was based on clinical and radiological examination. A thorough neurological examination was carried out in each case.

Selection of the Points
Points were selected according to the site of pain and clinical manifestation of the disease. Following points were taken in all the cases:

Local Point	Baihui	(GV-20)
	Dazhui	(GV-14)
	Tianshu	(UB-10)
	Dashu	(UB-11)
	Fengchi	(GB-20)
	Jain Jing	(GB-21)
Supplementary Points:
A.Upper extremity	Hegu	(LI-4)
	Quchi	(LI-11)
	Houxi	(SI-3)
	Lieque	(L-7)
B. Lower extremity:	Netting	(ST-44)
	Shenami	(UB-62)
	Yanglinguan	(GB-34)
	Xuan Zhong	(GB-39)
Ear Points	Shenmen
	Carvical spine area
	Points were added to the above group depanding  upon the symptom.

Stimulation :

All the points were stimulated with Electro-Stimulator Model A.F.I. 7901 (Made in India) for 20-30 minute daily with adjustable wave with a frequency of 60-12 per minute.

Course of Therapy
One sitting of 30 minute daily was for 10 days. The course was repeated after a rest of 7-10 days if symptom was not relieved.

Criteria for assessment of response :
I. Excellent         :    Relief from all thesymptoms for over 6 months.
II. Good              :    Relief from all the symptoms lasting for less than 6 months.
                                On reappearance, the symptoms are relieved with a short course of  treatment.
III. Poor             :    No lasting relief from the symptoms.

OBSERVATION

Out of 90 cases of cervical spondylosis studied 17(18.9%) were below the age of 30 years, 46 (51%) between 31-50 years & 27(30%) above 51 years. The male female ratio was roughly 2:1.
Only 13 cases (14.4%) had a duration of symptoms of less than 1 years. 34 cases (37.8%) had symptoms for more than 5 years.
Pain in the neck and stiffness were the commonest symptoms. The incidence of various types of neurological deficit varied from 9 to 17% No case presented with cranial nerve or spinal cord involvement.
Excellent response was obtained in 70% cases and good response in 20%. In only 10% cases the response was poor.
In 8 out of 9 cases where the response was poor the duration of disease was more than 5 years. With shorter duration of symptoms the likely hood for excellent or good response was more.

DISCUSSION

Acupuncture therapy provided significent relief from pain and stiffness in 90% cases of Cervical spondylosis. The pain in cervical spondylosis is produced by irritation of the sensory roots by asteophytes. The pain is of redicular type and is projected on the surface of the body at the site of corresponding dermatome. Apart from perception of pain, the irritation of sensory roots also stimulates the local reflex are resulting into spasm of muscles in the region. The muscular spasm is basically a protective phenomenon. Its function is to limit the movement of spine so that sensory root irritation is limited. But continuous muscular spasm itself is capable of producing pain due to increase in muscular tension and irritation of sensory nerve endings in the muscule. This further activates the pain spasm - pain cycle and aggracates the pain.

The relief of pain obtained with acupuncture anaglesia can be explained on the basis of :
1. Closure of sensory gate.
2. Breaking of vicious cycle of pain-spasm-pain.

Our observation favours the second hypothesisi because.
1. Pain was associated with stiffness in 70% cases. Stiffness was relieved in all cases with relief of pain. Indicating an interruption of local reflex arc.
2. The response was 100% in early cases as opposed to 47% when duration was more than 5 years. In early cases pain is more likely to be due to structural changes. A better response in early cases favours this possibility.
3. The results were better in the absence of neurological deficit.
Even in the presense of neurological deficit like motor weakness, a response of 75% was seen. This may be explained on the basis of theories like motor gate therapy of Jayasuriya & Fernando.

CONCLUSION:

Acupuncture therapy was found to be beneficial in cervical spondylosis. In 90 patients treated, good to excellent results were obtained in 20% and 70% cases respectively. Therapy was more success in treating cases where the symptoms were of a shorter duration and less success in aged patients and in those with marked osseous lesions.

TABLE NO. I
Showing age & sex Incidence

S.No.	Age Group	Male	Female	Total	Percentage
1	15-30	10	7	17	18.9%
2	31-50	30	16	46	51.1%
3	51 & above	19	8	27	30.0%
Total		59(65.6%)	31(34.4%)	90	100.0%

TABLE NO. II
Showing Duration of Symptoms

TABLE NO III
Showing Clinical Feature when patient reported for Acupuncture Therapy

TABLE NO. IV
Showing response to Acupuncture Therapy

S.No.	Results	No. of Cases	Percentage
1	Excellent	63	70%
2	Good	18	20%
3	Poor	9	10%
	Total	90	100%

TABLE NO V
Table showing relation ship between duration of symptoms and therapeutic results