Vertebral artery cervical spondylosis (CSA) is a syndrome in which the vertebral artery is irritated or compressed by various mechanical and dynamic factors, resulting in narrowing and folding of the blood vessels and causing inadequate blood supply to the vertebrobasilar artery as the main symptom. The pathogenesis of the disease includes both dynamic and vascular factors [1], and its clinical manifestations are mainly vertigo and headache. Tui na combined with acupuncture is a common clinical treatment for this disease.
1. Data and methods
1.1 General data A total of 24 patients between 18 and 65 years of age who met the diagnostic criteria of vertebral artery cervical spondylosis (with reference to the minutes of the Second National Symposium on Cervical Spondylosis in 1993 [2] and the relevant criteria of the 1985 textbook of the National College of Higher Medical Sciences, “Tui Na”) were included in the study according to the principle of informed consent for clinical trials, of whom 6 were male and 18 were female, with an average age of 46.38 ±11.20 years old.
1.2 Treatment method The treatment of tui-na was based on the principle of relaxing the tendons and meridians, and the specific operation was as follows: the patient took a sitting position, and the doctor stood at his side or behind him. Using one-finger Zen pushing, rolling and kneading methods, the patient was operated on the back of the neck and back for 5 minutes; at the painful pressure point on or beside the spinous process of the cervical vertebrae, the patient was pushed with one-finger Zen pushing from Fengfu to Dazhi point for about 2 minutes; the thumb pressed and rubbed the painful points at the anterior oblique muscle, middle oblique muscle and supraclavicular fossa for 3 minutes; the thumb pressed and rubbed along the sternocleidomastoid muscle for 5 minutes; the neck was lifted and pinched and the neck was stretched for 1 minute; the shoulder well was taken for 5 times. Same posture for head and face treatment as above. Push the forehead and face 5 times; press and rub the Yin Tang, Sun, Fish Waist and Baihui points for 2 minutes; sweep the bile meridian on the side of the head, 10 times each on the left and right; apply the five-finger holding method on the top of the head 5 times.
Acupuncture treatment is based on Fengchi, Baihui, Dazhi and cervical spine points. The specific operation is: take No. 30 1-1.5 inch milli-needle, point routine sterilization, rapid needle into the subcutaneous, slow needle into the acupuncture point, after the line of acupuncture to obtain gas, retain the needle for 20 minutes.
The above treatment is carried out once a day for 30 minutes each time. 5 times is a course of treatment, a total of 3 courses of treatment.
1.3 Observation index
Symptom function score: Referring to Wang Chuhuai’s Cervical Vertigo Symptom and Function Assessment Scale [3], the observation scale of this study was developed, and the scale graded the severity of the main clinical symptoms (vertigo, neck and shoulder pain, headache) of vertebral artery-type cervical spondylosis and the degree of influence on daily life and psychology, respectively. The changes of the scores before and after the treatment were observed.
Plasma endothelin: 2ml of fasting venous blood was taken from the patients in the group before and after treatment in the early morning, placed in pre-chilled test tubes, and the specimens were sent to the Laboratory Department of Jiangsu Provincial Hospital of Traditional Chinese Medicine for analysis and determination by radioimmunoassay.
1.4 Statistical analysis Statistical processing of the observation results was completed using SPSS 13.0 software, and the t-test was used for self-control before and after treatment.
2, Results
2.1 Comparison of total symptom function scores before and after treatment The total symptom sign scores of 24 patients with vertebral artery type cervical spondylosis were compared before and after treatment: 12.42±2.85 before treatment and 25.44±3.11 after treatment, and the total symptom function scores were significantly higher after treatment than before treatment, with statistically significant differences (P<0.01). It indicates that tui na combined with acupuncture can significantly improve the symptom function scores of patients with vertebral artery type cervical spondylosis.
2.2 Changes in vertigo symptom scores before and after treatment The vertigo symptom scores of 24 patients with vertebral artery-type cervical spondylosis were compared before and after treatment: 6.58±1.98 before treatment and 14.17±2.26 after treatment, and the vertigo symptom scores were significantly higher after treatment than before treatment, and the difference was statistically significant (P<0.01). It indicates that tui na combined with acupuncture can significantly improve the vertigo symptoms of patients with vertebral artery type cervical spondylosis.
2.3 Changes in daily life and psychological impact scores before and after treatment The daily life and psychological impact scores of 24 patients with vertebral artery-type cervical spondylosis were compared before and after treatment: 1.54±0.83 before treatment and 3.67±0.64 after treatment, the daily life and psychological impact scores after treatment were significantly higher than those before treatment, and the difference was statistically significant (P<0.01). It indicates that tui na combined with acupuncture can significantly improve the daily life and psychological impact scores of patients with vertebral artery-type cervical spondylosis.
2.4 Changes in plasma endothelin before and after treatment Because one patient was found to have significantly abnormal plasma endothelin before and after treatment in the statistics, it was considered as extreme value and treated as shedding, and another five patients did not comply with blood collection after treatment, so a total of 23 cases were involved in the statistics before treatment and 18 cases were involved in the statistics after treatment. The change of plasma endothelin level before and after treatment: 40.56±19.39 (pg/ml) before treatment and 36.26±14.00 (pg/ml) after treatment, the plasma endothelin after treatment was significantly lower than that before treatment, and the difference was statistically significant (P<0.01). It indicates that tui na combined with acupuncture can significantly reduce the plasma endothelin level in patients with vertebral artery type cervical spondylosis.
3. Discussion
The pathogenesis of vertebral artery-type cervical spondylosis has long been recognized differently in the medical community at home and abroad, and the treatment methods vary [4]. At present, the pathogenesis is summarized as mainly including (1) mechanical compression factors. The hyperplastic bones of the cervical spine can cause the transverse foramen of the vertebral body to become smaller and distortion and narrowing of the vertebral artery to occur. It has also been shown that there is a relationship between atlantoaxial joint disorder and the occurrence of cervical vertigo [5]. (2) Sympathetic nerve stimulation factors. The vertebral artery receives innervation from the sympathetic plexus formed by the stellate ganglion and the middle cervical ganglion, and when stimulated in various ways, it can cause symptoms such as spasm of the vertebral artery and brainstem ischemia. (3) Posterior cervical soft tissue lesion factors. Long-term neck strain or wind and cold can cause tension and spasm of soft tissues in the neck, resulting in abnormal proprioception and vertigo symptoms. (4) Hemodynamic factors. Recent studies have shown that endothelin and other vasoconstrictive substances can also lead to the occurrence of vertebral artery spasm [6].
In contrast to the above pathogenesis, the main mechanisms for the treatment of vertebral artery-type cervical spondylosis by combining acupuncture with tuina are (1) activating blood circulation and removing blood stasis, and draining the meridians and channels. In this study, the combination of acupuncture treatment not only significantly improved all the main clinical symptoms of vertebral artery-type cervical spondylosis, but also significantly reduced the level of plasma endothelin, a constricting substance, indicating that the combination of acupuncture treatment can effectively improve blood circulation in the neck, reduce constricting substances that cause spasm of the vertebral artery, improve soft tissue strain at the back of the neck, and Delay the degenerative process of the cervical spine. (2) Adjustment of cervical spine joint balance. In this study, the combination of acupuncture treatment can significantly improve clinical symptoms such as vertigo and headache. The reason for this is that in acupuncture treatment, the intervertebral joint and atlantoaxial joint disorders are adjusted, the intervertebral foramen is enlarged, the physiological curvature of the cervical spine is restored, the spasm of the cervical muscles is relieved, the internal and external biomechanical balance of the cervical spine is reestablished, and the cervical proprioceptive function is improved [7], thus reducing the symptoms of vertigo and headache caused by insufficient blood supply to the brain and tension in the cervical muscles. symptoms.
In addition, it was found in this study that tui na combined with acupuncture also significantly improved patients’ life and psychological impact scores and improved their quality of life. Quality of life assessment is a crucial clinical outcome for patients that has received little attention in previous studies. The symptom function scale used in the study may provide some reference for the clinical evaluation of vertebral artery cervical spondylosis.
Due to the strict inclusion criteria of the study, the exclusion of many patients with vertebral artery-type cervical spondylosis with multiple coexisting pathogenic factors that may interfere with the study results, and the influence of factors such as patient compliance and study time frame, the study collected fewer cases and a few patients failed to complete post-treatment plasma endothelin level measurement, which may have influenced the study results. Future studies could be conducted with parallel randomized controls to understand the clinical effects of different treatments, and the sample size could be further expanded to make the study more objective and realistic. The observation of vasoconstrictor substances can also be expanded, and an attempt can be made to study some diastolic substances with their counterparts, such as calcitonin gene-related peptide [8] and nitric oxide [9], to exclude the possible bias brought by a single factor.