The principle of treatment for cervical spondylosis should first consider conservative treatment, which can generally lead to symptom relief and improvement in most patients, and among the conservative treatments, acupuncture is one of the treatments with advantages.
1.Factors affecting the efficacy of acupuncture
(1) The type of lesion: there are more types of cervical spondylosis, and the type of lesion is directly related to the efficacy of acupuncture. Generally speaking, cervical cervical spondylosis is the lightest type of cervical spondylosis, characterized by pain in the occipital neck, restricted neck movement, stiffness of the cervical muscles, with corresponding pressure pain points, and only changes in the physiological arc of the cervical spine in the lesioned segment, which is considered by some to be the preliminary stage of cervical spondylosis, and even by some scholars to be cervical myofasciitis, which is a simple soft tissue spasm or inflammatory lesion, and acupuncture has the best efficacy for this type, with a short course of treatment, and can The best effect of acupuncture for this type is that the treatment course is short and clinical cure can be achieved. The neurogenic type is also superior to the vertebral artery type, while the sympathetic, spinal and esophageal types are less effective. In particular, the spinal cord type is directly compressed by the spinal cord, which is more complicated than the nerve root type and vertebral artery type, and it is easier to improve the functional status of the nerve root edema and vertebral artery than to improve the compressed edema of the spinal cord. The efficacy of acupuncture is ranked as cervical type > nerve root type > vertebral artery type > sympathetic type, spinal cord type.
(2) Nature and degree of lesion: Except for cervical cervical spondylosis, various other types of cervical spondylosis have differences in the degree of lesion even for the same type, and the degree of lesion is directly related to the efficacy of acupuncture. In cervical disc herniation, the herniated nucleus pulposus irritates or compresses the nerve roots or spinal cord, and its symptoms and signs are more volatile, but acupuncture treatment can achieve significant efficacy; in general, acupuncture for nerve root stimulation is more effective than for obvious nerve root compression. Cervical disc herniation is better treated with acupuncture than prolapse. The so-called cervical disc prolapse is when the nucleus pulposus enters the spinal canal through the ruptured posterior longitudinal ligament and suddenly develops heavy nerve root and spinal cord symptoms, and early acupuncture treatment can be effective, but should be combined with other comprehensive treatment. The damage to the spinal cord and nerve roots caused by a single disc lesion or osteophyte is certainly less severe than that caused by multiple disc lesions, so acupuncture is more effective for a single disc or osteophyte lesion than for multiple lesions. Comparatively speaking, acupuncture is more effective for intervertebral disc cervical spondylosis than for osseous origin.
Osteogenic cervical spondylosis is mainly caused by the stimulation and compression of the spinal cord, spinal nerve, sympathetic nerve and vertebral artery by the enlarged bone superfluous, the size of the sagittal diameter of the spinal canal is directly related to the occurrence and development of the disease and has a decisive influence on the efficacy of acupuncture. This type of cervical spondylosis is difficult to be treated with acupuncture because acupuncture cannot directly stimulate the lesion. The lateral-posterior type has the bones on one side, stimulating the edge of the spinal cord and spinal nerve roots, causing ipsilateral nerve roots and spinal cord symptoms, and acupuncture can play a better therapeutic role for nerve root symptoms. The hook vertebral joint type is caused by joint osteophytes, which stimulate the vertebral artery and spinal nerve roots respectively or simultaneously, causing vertebral artery type and nerve root type, for which acupuncture has certain therapeutic effects. Esophageal compression type and diffuse type acupuncture is difficult to achieve curative effect. For spinal cord degeneration caused by long-term compression of the spinal cord, acupuncture is difficult to obtain results. Of course, sometimes the clinical manifestations of cervical spondylosis and the degree of compression are not proportional, which may be related to individual differences and the ability of self-replacement.
Osteogenic changes in the cervical spine do not necessarily cause clinical symptoms, and clinical manifestations of spinal cord and nerve damage often appear immediately after occasional minor trauma. This is because the spinal cord tissue is more resistant to chronic wear and tear and chronic external pressure, but can not tolerate even minor acute injury, so the effectiveness of acupuncture depends on the different degrees of damage to the nerve tissue, the degree of injury is light acupuncture is effective. Whether it is congenital or acquired spinal stenosis, the degree of stenosis is light acupuncture is more effective.
(3) The course of the disease: cervical spondylosis should be treated early, the shorter the course of the disease, the better the curative effect. Longer and slower course, although the symptoms are lighter, acupuncture efficacy does not necessarily belong to the excellent; shorter course, the condition may be heavier, although the recovery after acupuncture treatment is often faster, and the efficacy is good. This may be mainly related to the long duration of the disease, the local pathological damage has been fixed, it is difficult to reduce or recover.
(4) patient’s cooperation: during treatment, the patient’s head and neck activities should be restricted, and braking should be applied to those with cervical instability. After healing, excessive shaking of the head and neck should be avoided, correction of poor posture at work, avoiding prolonged forward bending of the head and neck or turning to one side, in order to maintain the physiological curve of the head, neck and chest is good. These are all related to the recent and long-term efficacy of acupuncture.
Foreign scholars have also provided some evidence about acupuncture for cervical spondylosis, such as Caon RM et al. (American journal of Chinese medicine 1981), who used a randomized controlled study and showed that after 12 weeks of acupuncture treatment, patients’ condition improved significantly, with an average of 40% reduction in pain, 54% less use of painkillers, and 68% less daily pain time. 68%, and 32% had less restriction of activity. Studies by David (British Journal of Rheunmatology 1993) and others in the United Kingdom have also confirmed that both acupuncture and physical therapy are effective treatments for chronic neck pain.
It should be noted that acupuncture can also usually only improve the symptoms of cervical spondylosis caused by degenerative lesions (osteophytes, etc.) and disc herniation, which manifest as chronic neck and arm pain and numbness of the fingers, as well as headache and dizziness due to compression of the vertebral artery, without the possibility of changing the organic changes that occur in the cervical spine. Therefore, there will be no changes in X-ray or CT imaging before and after treatment. However, this also reminds us that the clinical symptoms of cervical spondylosis are clearly caused by its local soft tissue inflammation and edema or compression of the spinal nerve or vertebral artery by the bony mass, and that the lesions of the cervical spine itself only provide the local abnormal environment and conditions for the development of the disease, making it susceptible to injury during daily activities. This is precisely why we sometimes see in clinical practice that the severity of degenerative changes in the cervical spine itself and the presentation of clinical symptoms are not entirely consistent. Therefore, acupuncture can only achieve symptom relief by improving local microcirculation, promoting inflammatory absorption, and relieving pain by eliminating factors such as local inflammatory irritation.
2.Links and mechanisms of acupuncture treatment
Acupuncture treatment for cervical spondylosis, like other conservative therapies, can usually only relieve symptoms and cannot change the organic changes already present in the cervical spine. The links and mechanisms of acupuncture for cervical spondylosis include.
(1) Pain relief: acupuncture facilitates cervical spine movement by relieving muscle tension and spasm, while providing pain relief. In addition, acupuncture can also achieve pain relief by promoting the release of endogenous analgesic substances in the body, weakening or antagonizing the nociceptive afferents of sensory nerves and raising the pain threshold, etc.
(2) Promote local microcirculation: After the nerve root is stimulated or compressed, the aseptic inflammation around the nerve root inevitably leads to exudate filling in the intervertebral foramen and its surrounding soft tissues, which increases the pressure between the tissues, and acupuncture can promote local metabolism and absorption of inflammatory products by stimulating local microcirculation, so as to achieve the effect of “drainage and decompression The effect of “drainage and decompression” can eliminate or relieve the various factors in the nerve root canal that compress and restrict the activities of the nerve roots, which can loosen the adhesions between the nerve roots and soft tissues and relieve the symptoms.
(3) Improving blood supply to the vertebral artery: A large number of experimental studies have shown that acupuncture points such as Fengchi in the cervical region can stretch the vertebral artery and increase its blood supply, thus relieving symptoms such as vertigo.
(4) Coordinating the muscles and ligaments around the intervertebral discs: Recent studies have concluded that degeneration or injury of the cervical spine is an irreversible pathological factor, and that its secondary pathological changes, causing a disorder of kinetic balance, are the key pathogenic mechanism. Because the main function of the cervical spine is to bear the weight of the head and maintain cranial balance, and to adapt to the stimulus response of hearing, smell, and vision, and have greater acuity and mobility, the realization of these functions is accomplished through the complex and tightly organized activity regulation of the cervical vertebrae and their connected structures, i.e., “activity” is the key to its function, and if it loses If “activity” is lost, the mechanical balance of its “movement” is out of balance, its static mechanics and stability cannot be adjusted at any time, the stiffness and strength of the spine is abnormal, endogenous and exogenous stability is damaged, and the compression, tension, torsion, shear and other loads of the cervical spine are altered, resulting in ectopic compression or chemical compression. This leads to ectopic compression or chemical stimulation causing cervical spondylosis. After the occurrence of cervical spondylosis, the local muscles, ligaments and tendons of the lesion are in an imbalanced biomechanical state. Through local stimulation, acupuncture can coordinate them and reduce their spasticity, thus relieving the tension of the local muscles, tendons and ligaments, relieving pain, reducing the pressure on the intervertebral discs, nerves and blood vessels, and facilitating the repair of local blood circulation and tissue damage.
(5) Neuromodulation: acupuncture can directly stimulate nerves and cause nerve impulse conduction, which has the effect of reflexively promoting nerve cell metabolism and self-repair for the stimulated and compressed nerve roots. Foreign scholars Peng AT et al. (“Acupuncture &Electro-Therapeutics Research” 1987) showed that electroacupuncture treatment of chronic neck and shoulder pain can obtain 64.9% significant long-term improvement, and that its principle of action is that electroacupuncture organizes the peripheral sympathetic nerves, causing increased local microcirculation and promoting tissue healing and pain relief.
Overall, cervical, radicular, and vertebral artery types of cervical spondylosis are common in clinical practice, and most patients can have their symptoms improve or disappear with non-surgical treatment, but they can often have recurrent episodes. Most patients with cervical spondylosis generally have a pattern of acute attacks to remission, re-attacks, and remission. Most patients with cervical spondylosis have a good prognosis.
Cervical cervical spondylosis is not caused by cervical spine osteophytes but by changes in the physiological curvature of the cervical spine and strain on the soft tissues of the neck, and therefore has a good prognosis.
The prognosis of nerve root type cervical spondylosis varies, among which the root pain type has a good prognosis, the atrophy type is poor, and the numbness type is between the two; those caused by simple cervical nucleus pulposus protrusion have mostly good prognosis and few recurrences after cure; those whose nucleus pulposus has formed adhesions are prone to residual symptoms; those caused by hook spine joint hyperplasia have more satisfactory prognosis with early and timely treatment. If the disease duration is long and subarachnoid adhesions have formed at the root canal, the prognosis is less satisfactory due to prolonged symptoms. In patients with extensive osteophytes, treatment is not only complicated, but also the prognosis is poor.
The prognosis of vertebral artery cervical spondylosis is mostly good, especially for those with instability of vertebral joints, and the prognosis of cases with severe symptoms treated by surgery is also satisfactory. Vertebral artery type cervical spondylosis mostly occurs after middle age and has a more serious impact on brain power, but has no significant impact on physical strength, and there are cases of hemiplegia due to insufficient blood supply to the vertebrobasilar system, but it is less common.
Spinal cord cervical spondylosis is more serious in terms of physical strength, and if it is not treated actively, it will lead to lifelong disability, but has little effect on brain power. Generally speaking, this type is mainly treated by surgery. The prognosis is better for those with herniated or prolapsed discs; the prognosis is worse for those with a significantly narrow sagittal diameter of the spinal canal with large bone spurs or calcification of the posterior longitudinal ligament; the prognosis is worst for those with more than one year of severe disease, especially those with degeneration of the spinal cord; the prognosis is also worse for the elderly, especially those with serious systemic disorders or poor function of major organs (heart, liver, kidney, etc.).
In the acute phase of neurogenic cervical spondylosis, prolonged insertion of electrical activity, abnormal spontaneous potentials such as fasciculation potentials, fibrillation potentials and positive sharp waves during muscle relaxation, and a decrease in the number of motor unit potentials and wave amplitude during muscle contraction are often observed. In those with longer disease duration, an increase in motor unit potential phase, prolonged time frame and increased wave amplitude were observed. This is consistent with the clinical pathogenesis, because in neurogenic cervical spondylosis, the pathological changes are mainly due to various factors that cause excitation pressure on the nerve root, and as the disease progresses, the inflammatory reaction at the root cuff gradually fibrosis, or even Wallerian degeneration, and thus muscle loss of nerve potential. In the recovery period, the repair process of the damaged nerve shows a large regenerative potential, indicating that the muscle has regained innervation and the prognosis is good.
In the clinical diagnosis of cervical spondylosis, imaging is often considered the most accurate method. This is because the pathological changes in soft tissues are not always visualized, but there are often positive findings in electrophysiological examination. and prognosis.
In addition, patients themselves should strengthen the exercise of neck and shoulder muscles and avoid the bad habit of sleeping with a high pillow, with a pillow height of 8 to 15 cm, or according to the formula (shoulder width – head width) ÷ 2. The cervical pillow can also play a preventive or therapeutic role. Pay attention to the neck and shoulder warmth, avoid head and neck weight, etc.