Clinical Observation on Acupuncture Combined with Hyperbaric Oxygenation in Treating Patients with Cervical Spondylosis of Nerve Root Type in Acute Phase

Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China

CLINICAL STUDY

Clinical Observation on Acupuncture Combined with Hyperbaric Oxygenation in Treating Patients with Cervical Spondylosis of Nerve Root Type in Acute Phase

Wang Jian-xiong, Zhang Jun-feng

Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China

Author: Wang Jian-xiong, associate chief physician, associate professor.

E-mail: jxjx1962@hotmail.com

Objective: To observe the therapeutic efficacy of acupuncture combined with hyperbaric oxygenation for cervical spondylosis of nerve root type in acute phase.

Methods: One hundred cases with cervical spondylosis of nerve root type in acute phase were randomly divided into two groups, with 50 patients in each group. The patients in the treatment group were treated by acupuncture combined with hyperbaric oxygenation, and those in the control group only received the same acupuncture therapy as the treatment group. The therapeutic efficacy was evaluated after 2 courses of treatment.

Results: In the treatment group, 27 cases were cured, 9 cases showed markedly effective, and 4 cases were invalid, and the recovery rate was 67.5%, the total effective rate was 90.0%; in the control group, 18 cases were cured, 17 cases showed markedly effective, 15 cases were invalid, and the recovery rate was 36.0%, the total effective rate was 70.0%. There were statistically significant differences between two groups in the recovery rate and the total effective rate (bothP＜0.05). The average cure time of the treatment group was (15.56±7.13) d, and that of the control group was (22.13±7.78) d, which also had significant difference between the two groups (P＜0.05).

Conclusion: Acupuncture combined with hyperbaric oxygenation has rapid and reliable effects for cervical spondylosis of nerve root type in acute phase.

Acupuncture Therapy; Hyperbaric Oxygenation; Spondylosis; Neck Pain

Cervical spondylosis is one of the common and frequently encountered diseases in acupuncture clinic, and nerve root type is the most common subtype. Acute cervical spondylosis of nerve root type causes pain that radiates to the arm, neck, upper back and/or shoulders. Patients may experience muscle weakness and/or numbness or tingling in fingers or hand. These symptoms can seriously impact on patients’ work and life. In recent years, the cervical spondylosis of nerve root type has a tendency to affect the younger people. The previous conservative treatments for this disease mainly include acupuncture and moxibustion, tuina, physiotherapy, traction, oral medicine, and external paste medicine, which all have certain clinical therapeutic efficacy. The basic pathogenesis of the disease is nerve roothypoxia due to irritation or compression to the nerve roots, while hyperbaric oxygenation can increase the oxygen tension of the injured cervical nerve root and improve its microcirculation. Therefore, this study observed the clinical effect of acupuncture combined with hyperbaric oxygenation in treating cervical spondylosis of nerve root type in acute phase, and the conclusions are summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

Diagnostic criteria referred to theGuiding Principles for Clinical Study of New Chinese Medicinespromulgated by the State Administration of Traditional Chinese Medicine[1]andShanghai Diagnostic and Therapeutic Guidelines of Traditional Chinese Medicine(second edition) promulgated by Shanghai Municipal Public Health Bureau[2]: a history of chronic strain, or wind and cold attacking, or trauma, or cervical degenerative changes; mainly affecting people over 40 years old, and the people who have to work in a bow position for a long time or who spend a lot of time on watching TV or videotape, usually presenting a chronic onset of the disease; neck pain radiating to the upper limb, worsened when the neck extends backward, with a decreased sensation in the skin segment of compressed nerve root distribution area as well as tendon reflex abnormalities, plus muscle atrophy, decreased muscle strength and limited neck movement, and positive traction test and Spurling test; X-ray anteroposterior radiograph showing uncovertebral joint hyperplasia and an deviated odontoid process in open mouth position, lateral radiograph showing that cervical curvature becomes straight, intervertebral space becomes narrower, with bone hyperplasia or ligament calcification, and oblique radiographs showing that intervertebral foramen becomes smaller. CT and MRI examinations usually have significance for the qualitative and positioning diagnosis.

1.2 Inclusion criteria

Those in conformity with the diagnostic criteria of cervical spondylosis of nerve root type; aged between 24 and 60 years old, disease durations within 5 d, no gender limitation; other therapies were stopped in the treatment process; they voluntarily joined the clinical study and signed the informed consent forms.

1.3 Exclusion criteria

Those complicated with cervical spondylosis of vertebral artery type, spinal cord type or sympathetic type; Those who were suffering from a systemic collagen autoimmune disease and/or other acute, chronic infection causing the application of glucocorticoid medicines at the same time, which might affect the result; those whose disease condition worsen or had serious complications in the process of study; those who had hyperbaric oxygenation contraindications.

1.4 Rejection criteria

Those who had allergic reactions or serious adverse reactions during the treatment process should be eliminated according to the doctors’ advice, however, those who had completed more than 1/2 treatment course were included in the statistics of therapeutic efficacy; those whose disease condition had worsen and might undergo dangerous event during the study had to be eliminated on the base of doctors’judgment, which meant that the patients should be withdrawn in the study, and even if they had completed more than 1/2 of treatment course, they were still counted as invalid cases statistically.

1.5 Statistical methods

All data were analyzed statistically by SPSS 18.0 version statistical software. Measurement data were expressed as mean ± standard deviationand analyzed byt-test; rates were compared by Chi-square test.P＜0.05 indicated that the difference was statistically significant.

1.6 General data

One hundred cases with cervical spondylosis of nerve root type in acute phase were randomly divided into two groups following visiting sequences on the base of a random number table, with 50 patients in the treatment group and 50 in the control group. However, 10 patients who met the exclusion criteria were excluded, and finally 90 patients had completed the treatment. There were no statistical differences in age, gender, duration and other general data between the two groups (P＜0.05), which meant that the two groups were comparable (Table 1).

The clinical flow chart of the two groups is showed in Figure 1.

Table1. Comparison of general data between the two groups

Figure 1. Clinical flow chart of the two groups

2 Therapeutic Methods

2.1 Treatment group

2.1.1 Acupuncture therapy

Major acupoints: Fengchi (GB 20), Tianzhu (BL 10), C4-6Jiaji (EX-B 2) acupoints, Jianjing (GB 21), Bingfeng (SI 12), Jianliao (TE 14), Quchi (LI 11), Shousanli ( LI 10), Waiguan (TE 5), Hegu (LI 4).

Adjunct acupoints: Sanyinjiao (SP 6) was added for type of blood stasis; Hegu (LI 4) for type of coldness and dampness; Yinlingquan (SP 9) for type of dampness and heat; Taixi (KI 3) for type of liver and kidney deficiency.

Operation: The acupoints on the affected side were selected and disinfected by Lionser compound lodine disinfectant liquid. Stainless steel filiform needles of 0.25 mm in diameter and 40 mm in length were used, and inserted into the skin for 1.2 cun by fingernail-pressure needle inserting method. After arrival of qi, reinforcing-reducing of twirling rotating manipulation was performed for 5 min each acupoint each time, causing a sense of soreness and distention, which can radiate to the upper extremity. The needles were retained for 20 min.

There were 5 acupuncture treatments per week, with breaks at weekend, and 10 times as a course of treatment, and the patients had to continuously complete two courses of treatments (a total of 4 weeks).

2.1.2 Cupping therapy

After acupuncture, flash-fire cupping was given to the affected side’s neck and back, and the cups were retained for 5 min.

2.1.3 Hyperbaric oxygenation

A large hyperbaric oxygen chamber was used to pressurize for 10-15 min with pressure of 0.1 MPa, and the patients were asked to wear oxygen mask, with a break of 10 min to absorb the air in cabin. Finally, after 20-30 min, let the patients walk out of the cabin after decompression.

There were 5 treatments per week with breaks at weekend. And 10 treatments constitute a course, and the patients had to be continuously treated for 2 courses (a total of 20 times in 4 weeks).

2.2 Control group

Patients in the control group were treated by the same acupuncture and cupping therapies. And the treatment method and duration were also the same

3 Therapeutic Efficacy Observation

3.1 Therapeutic efficacy criteria

With reference to the therapeutic efficacy criteria of cervical spondylosis inShanghai Diagnostic and Therapeutic Guidelines of Traditional Chinese Medicine(second edition) promulgated by Shanghai Municipal Public Health Bureau[2].

Recovery: All the symptoms disappeared, with normal muscle strength and normal neck and limb functions, and the patient were able to participate in labor and work normally.

Improvement: A variety of symptoms relieved, neck and back pain relieved, and neck and limb functions improved.

Invalid: There was no relief of the symptoms.

3.2 Therapeutic results

3.2.1 Inter-group comparison of clinical therapeutic efficacy

The recovery rate of the treatment group was 67.5%, and the total effective rate was 90.0%; the recovery rate of the control group was 36.0%, and the total effective rate was 70.0%; there was a significant difference between the two groups in the recovery rate and the total effective rate (allP＜0.05), which indicated that the treatment group was more effective than the control group (Table 2).

3.2.2 Inter-groups comparison of the average days of recovery

The average days of recovery in the treatment group was (15.56±7.13) d, and it was (22.13±7.78) d in the control group, and there was a significant difference between the two groups according to statistical analysis (P＜0.01), which indicated that the average cure days of the treatment group was shorter than that of the control group.

Table 2. Inter-group comparison of clinical therapeutic efficacy (case)

4 Discussion

As an important part of traditional Chinese medicine, acupuncture treatment for cervical disease has advantages such as high efficacy, low cost, and less adverse reactions. It has effects of dredging meridians, expelling wind and cold and stimulating Qi and blood circulation to acupuncture Jiaji (EX-B 2) points combined with acupoints of the Three Yang Meridians of Hand such as Bingfeng (SI 12), Jianliao (TE 14), Quchi (LI 11), Shousanli (LI 10), Waiguan (TE 5), Hegu (LI 4) and so on. Acupuncture can improve local blood circulation, relieve muscle spasm and resolve and absorb nerve root edema to release local adhesions and nourish nerves that is why it can relieve the clinical symptoms.

Cervical spondylosis is mainly caused by degeneration of cervical spine and cervical disc. Ligament relaxation and disc space narrowing result in decreased stability of the cervical spine, thereby causing vertebral body, facet joints and ligaments degeneration, proliferation and calcification, which finally irritate or compress nerve root and induce a series of clinical symptoms[3]. When the nerve root is compressed, firstly epineurium and perineurium are compressed into a depression, then with increasing pressure, the basement membrane and myelin are affected, the nerve cell becomes edema, oxygen free radicals are produced and lipid peroxidation increases, resulting in microcirculation and nerve axonal transport disruptions as well as nerve cell ischemia, hypoxia and secondary necrosis[4-5].

Hyperbaric oxygenation can improve the oxygen tension of the neck after cervical nerve root injury, improve microcirculation, and promote collateral circulation and vascular lesion repair, and remedy hypoxic damage caused by blood circulation disorders[5]. Under 0.1 MPa oxygen pressure, arterial partial pressure of oxygen (PaO2) can reach up to 126 kPa, which is 10 times of inhaled air under normal atmospheric pressure, thus it can reverse or prevent from pathology change induced by secondary injury after nerve compression. Hyperbaric oxygenation can produce a lot of ATP, to reduce damage to Na+-K+-ATP enzyme in the nerve cell membrane and reduce nerve vascular permeability to relieve nerve cell edema[6-9]. Hyperbaric oxygenation can dilute the blood, accelerate blood flow and increase tissue blood flow to increase blood flow of nerve tissue, improve nerve oxygen supply, promote the recovery of nerve fiber morphology and function, and rescue the dying cells. In addition, hyperbaric oxygenation can reduce the swelling of the vegetation formed after the vertebral bone hyperplasia and the outburst soft tissue from disc surface and it can finally relieve nerve root compression degree[10-12].

This study has shown that acupuncture combined with hyperbaric oxygenation can relieve the patient's symptoms and signs and improve upper limb functions significantly, compared with the control group, the difference was statistically significant, indicating high effectiveness of hyperbaric oxygenation in treating cervical spondylosis of nerve root type, and the treatment can shorten the course of treatment and be worthy of clinical application.

Conflict of Interest

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

Acknowledgments

This work was supported by Shanghai Cultivation Plan of New Stars in Xinglin (No. ZYSNXD011-RC-XLXX-20130046); Lu’s Acupuncture Inheritance Study of Shanghai Schools of Traditional Chinese Medicine (No. ZYSNXD-CCHPGC-JD-004).

Statement of Informed Consent

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

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Translator: Deng Ying

R246.2

: A

Date: April 8, 2014