Ni Chun-chu, Yao Li-mei, Shen Zhi-fang, Yan Yu-qin

Jiaxing Hospital of Traditional Chinese medicine, Zhejiang 314001, China

Therapeutic Efficacy Observation on Combining Intermittent Traction with Warm Needling for Cervical Radiculopathy

Ni Chun-chu, Yao Li-mei, Shen Zhi-fang, Yan Yu-qin

Jiaxing Hospital of Traditional Chinese medicine, Zhejiang 314001, China

Objective: To observe the clinical effect of combined intermittent traction with warm needling for cervical radiculopathy.

Methods: A total of 100 cases with cervical radiculopathy were randomly allocated into an observation group and a control group. Cases in the observation group were treated with intermittent traction coupled with warm needling, whereas cases in the control group were treated with warm needling alone. The therapeutic efficacy was observed after 20-day treatment.

Results: The markedly effective rate in total was 90.0% in the observation group, versus 78.0% in the control group, showing a statistically significant difference (P＜0.05).

Conclusion: Combining intermittent traction with warm needling is safe, convenient and significantly effective for cervical radiculopathy. It is worth further popularization in clinical practice.

Traction; Warm Needling Therapy; Acupuncture Therapy; Moxibustion Therapy; Neck Pain; Spondylosis

Cervical radiculopathy is one of the common patterns (approximately 50%-60%) of cervical spondylosis. It often affects people aged between 30 and 50 years old. This condition is caused by chronic degenerative changes of the cervical spine, such as herniated cervical disc or bone spurs on either cervical facet or uncovertebral joint. These changes can, over time, compress one or more of the nerve roots, causing a series of symptoms on one or both sides. This condition is clinically characterized by pain and numbness on nerve root-involved areas. The pain in the neck and shoulder does not respond to nerve block injection[1]. In order to select a better treatment protocol for cervical radiculopathy, we treated 100 cases with intermittent traction coupled with warm needling between June 2012 and February 2013. The results are now summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

Typical radicular symptoms (numbness, pain) in the area where the nerve that is irritated travels; positive Spurling sign, brachial plexus tension test and separation test of intervertebral foramen; cervical X-ray shows that thephysiological cervical curve has been decreased, straightened or reversely curved; hyperplasia and osteophytes on uncovertebral or posterior joints of the involved segments; nuchal ligament calcification and narrowing of intervertebral spaces; MRI scan shows degeneration of affected cervical disc, herniated nucleus pulposus and compression to the nerve root; CT scan shows outgrowth on uncovertebral joint and posterior articular process as well as nerve root canal stenosis that are consistent with clinical manifestations; abnormal activities of the affected nerves by electrophysiological examination.

1.2 Inclusion criteria

Those who met the above diagnostic criteria and did not use other Chinese or Western medicine or receive other therapies before the study; aged between 19 and 60 years old; having ≤5 years of cervical radiculopathy; understood and agreed to participate in this study.

1.3 Exclusion criteria

Those with other conditions (not cervical) such as thoracic outlet syndrome, carpel-tunnel syndrome and scapulohumeral periarthritis; those with suspected or confirmed tumor in the vertebrae, spinal canal or brain; having coagulation disorders; having severe heart, lung and brain diseases; breast-feeding, pregnant or ready-to-be pregnant women; having unclear spinal injury coupled with symptoms of spinal cord injury; and those who failed to meet the above criteria, uncooperative during the treatment or having incomplete data.

1.4 Statistical method

The SPSS 17.0 version software was employed for statistical analysis, Chi-square test for ratio comparison andt-test for measurement data those were expressed with ().P＜0.05 indicates a statistical significance.

1.5 General data

A total of 100 cases (outpatients in Acupuncture Department of our hospital) who met the inclusion criteria were randomly allocated into an observation group and a control group, 50 cases in each group. There were no statistical differences in gender, age and duration between two groups (P＞0.05), indicating that the two groups were comparable (table 1).

Table 1. Between-group comparison of general data

2 Treatment Methods

2.1 Observation group

2.1.1 Intermittent traction

The PH-T3021FRA intelligent tepid tractizer [manufactured by Japan NIHON MEDIX (China) Group] was used for neck traction. After the two buttons of the occiput were stabilized, A-P angle, vertical distance and L-R angle were adjusted according to the patient’s condition and X-ray findings. Started the traction weight from 6-8 kg and gradually increased the weight (no more than 1 kg for each increase) if the patient had no discomfort. The maximum traction weight was no more than 20 kg. The traction lasted 30 min each time, with a 10-second interval every 30 s. The traction was done once every day, and 20 times made up a course of treatment.

2.1.2 Warm needling therapy

Major acupoints: Cervical Jiaji (EX-B 2) points (C3-7), Dazhui (GV 14), Tianzhu (BL 10), Fengchi (GB 20) and Houxi (SI 3).

Adjunct acupoints: Jianwaishu (SI 14), Quyuan (SI 13), Bingfeng (SI 12), Tianzong (SI 11), Jianyu (LI 15) and Shousanli (LI 10).

Method: After the local area was disinfected using a 75% alcohol cotton ball, the forementioned acupoints were perpendicularly punctured with filiform needles of 0.30 mm in diameter and 40 mm in length. Upon the arrival of needling sensation, moxibustion (moxa cones of 1.5 cm in length) were applied to Dazhui (GV 14), Fengchi (GB 20), Tianzong (SI 11) and Jianyu (LI 15), 2 cones for each acupoint. The needles were retained 30 min and the treatment was done once every other day. Ten times of treatment made up a course of treatment.

2.2 Control group

The same warm needling therapy as the observation group was employed in the control group.

3 Therapeutic Efficacy Evaluation

3.1 Criteria for therapeutic efficacy

The neurologic function was assessed before and after treatment using JOA scoring (17 points) by the Japanese Orthopaedic Association (JOA). The improvement rate was then calculated according to the scores.

JOA Improvement rate = (Post-treatment score﹣Pre-treatment score) ÷ (17﹣Pre-treatment score) × 100%.

Excellent: The JOA improvement rate ≥75%.

Good: The JOA improvement rate ≥50% but＜75%.

Fairly: The JOA improvement rate ≥25% but＜50%.

Poor: The JOA improvement rate ＜25%.

The excellence rate was the proportion of excellent improvement rate; and the markedly effective rate was the proportion of excellent and good improvement rates.

3.2 Treatment results

After one course of treatment, the excellence rate and markedly effective rate in the observation group were both significantly higher than those in the control groups (P＜0.05), indicating that the observation group should have a better clinical efficacy than the control group (table 2).

Table 2. Between-group comparison of therapeutic efficacies (case)

4 Discussion

In Chinese medicine, cervical radiculopathy falls under the category of ‘neck Bi-Impediment’. By activating meridian qi and dredging meridians, acupuncture can regulate qi and blood, balance yin and yang, alleviate inflammatory swelling, benefit muscles and ligaments, relieve nerve irritations and increase the patients’ pain threshold. Fengchi (GB 20) is a crossing point between the Gallbladder Meridian and Yang Link Vessel and can therefore connect all Yang Meridians. Dazhui (GV 14) is a crossing point between the Governor Vessel and all Yang Meridians of Hands and Feet and can therefore activate yang qi. Needling Fengchi (GB 20) and Dazhui (GV 14) can balance yin and yang, circulate blood to resolve stasis, unblock collaterals and generate qi and blood in the Yang Meridians. Located close to the occiput and associated with the branch of occipital artery and the greater occipital nerve stem, Tianzhu (BL 10) is believed to be a major point for neck pain. Needling Tianzhu (BL 10) can regulate qi of Governor Vessel and the Bladder Meridians and benefit the brain. As a confluent point with Governor Vessel, Houxi (SI 3) is often used for pain along the spine. Jiaji (EX-B 2) points are located close to the spine. Other than regulating qi and blood, needling Jiaji (EX-B 2) points can regulate the spinal nerves and sympathetic nerve to promote release of chemical mediators such as bradykinin, 5-hydroxytryptamine and acetylcholine, thus regulating the blood flow velocity and blood volume and accelerating blood circulation[2]. Warm needling therapy can warm and unblock meridians, circulate qi and blood, resolve dampness, dissipate cold, regulate sympathetic function, alleviate vascular and cervical muscle spasm, and thus relieve localized inflammation and alleviate symptoms[3-5].

In Western medicine, cervical radiculopathy is caused by diffuse aseptic inflammatory swelling compressing the nerve root due to loss or reversed curvature of the physiological cervical arch, herniated cervical disc, unstable vertebrae or osteophytes on uncovertebral joint[6]. Cervical degeneration is mainly accounted for cervical radiculopathy. Studies by Guo YF, et al have proven an accurate effect of cervical traction for radiculopathy[7]. They believe that traction can release cervical muscle spasm, increase intervertebral space, decrease pressure within the intervertebral disc, retract the herniated nucleus pulposus, correct facet derangement, stabilize cervical vertebrae, enabling the loosened ligamenta flava to become thinner. This can in turn increase the intervertebral foramen, relieve the compression to spinal cord, blood vessels and nerve root and alleviate symptoms. Since cervical curve can either accelerate or slow down the progression of cervical spondylosis, it is of great significance to realign the cervical curve[8-10]. Cervical spondylosis often affects multiple vertebrae, it is therefore important to conduct adjustment according to the images and personalized conditions. Studies by Wu ZD, et al have shown that the maximum stress was exerted on upper segments with a smaller traction angle, whereas the maximum stress gradually shifted downward when the traction angle was gradually increased[11]. Han CL, et al believed that it is advisable to conduct mild extension traction for patients with facet disorders[12]. Yang LX, et al also advised to select appropriate traction force and direction according to affected joints[13].

This study has suggested that combining intermittent traction with warm needling is safe, reliable and effective for cervical radiculopathy and it is worth further popularization in clinical practice.

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[13] Yang LX, Jiu T, Liu ZB, Tan LW, Sun ZP, Li ZB. Clinical observation of traction time and weight on the effects of nerve root cervical spondylosis. Xiandai Zhongyiyao, 2009, 29(3): 5-7.

Translator: Han Chou-ping

R246.2

A

Date: August 14, 2013

Author: Ni Chun-chu, bachelor, rehabilitation therapist.

E-mail: nichunchu@126.com