To observe the clinical efficacy of acupuncture with behavioral intervention in the treatment of cervical and neurogenic cervical spondylosis. Methods Patients with cervical and neurogenic cervical spondylosis were randomly divided into four groups, namely, the electro-acupuncture group, the electro-acupuncture and water-acupuncture group, the warm-acupuncture and water-acupuncture group and the drug control group. The clinical control rates were 30.0%, 36.7% and 33.3% in the electroacupuncture group, electroacupuncture group and warm acupuncture group, respectively, after 4 weeks of treatment, which were significantly higher than those of the drug control group by 10.0%; the clinical control rates were 60.0%, 80.0% and 73.3% after 8 weeks of treatment, respectively, which were significantly higher than those of the drug control group by 30.0%; the clinical control rates were 76.7% after 4 months of treatment or follow-up, respectively. The clinical control rates after 4 months of treatment or follow-up were 76.7%, 86.7%, and 80.0%, respectively, which were significantly higher than the drug control group of 50.0%. Conclusion Acupuncture with behavioral intervention is an effective solution for the prevention and treatment of cervical and neurogenic cervical spondylosis.
Cervical spondylosis, also known as cervical spine syndrome, refers to a series of symptoms caused by nerve and blood vessel compression due to cervical sprain or intervertebral disc degeneration and degenerative changes of vertebrae, and is a common and frequent disease among middle-aged and elderly people. With the increase in the number of people working with their heads down, such as the widespread use of computers and air conditioners, the chances of people flexing their necks and suffering from wind, cold and dampness are increasing, resulting in the increasing prevalence of cervical spondylosis, and the trend of a younger age of onset. In recent years, we have conducted a small sample randomized group comparison study in the acupuncture outpatient clinic, which is summarized as follows.
1. Clinical data
1.1 General data
There were 120 cases in this group, including 45 males and 75 females; the minimum age was 27 years old, the maximum age was 75 years old, and the average age was (50±13) years old; the shortest duration of disease was 3 d, and the longest was 30 years, including 29 cases within 1 month, 28 cases from 1 to 6 months, 12 cases from 7 to 12 months, 22 cases from 1 to 3 years, and 29 cases over 3 years. All the cases were outpatients, and the clinicians randomly assigned the patients into the simple electroacupuncture group, electroacupuncture-water acupuncture group, warm acupuncture-water acupuncture group and drug control group, 30 cases in each group according to the order of patients’ visits to the hospital and the pre-programmed random code.
1.2 Diagnostic criteria
Cases were selected with reference to the diagnostic criteria for cervical and neurogenic cervical spondylosis in the Diagnostic Efficacy Standards for Chinese Medical Evidence [1] of the State Administration of Traditional Chinese Medicine. (1) history of chronic strain or trauma, or congenital malformation of the cervical spine, cervical degenerative disease; (2) most often occur in middle-aged people over 40 years old, long-term low head workers or those who are accustomed to watching TV and video for a long time, often with chronic onset; (3) neck, shoulder and back pain, headache and dizziness, stiffness of the neck, numbness of the upper limbs; (4) limited function of neck movement, lesioned cervical spine, pressure pain in the upper corner of the affected scapula, and palpable striae The lesioned cervical spinous process and the affected side of the scapula often has painful pressure in the upper angle of the scapula. CT and magnetic resonance examination are meaningful for qualitative and localized diagnosis.
Cervical pattern
The pain in the occipital neck, restricted cervical movement, stiffness of the cervical muscles, and corresponding pressure points. x-ray radiographs show changes in the physiological curvature of the cervical spine at the diseased segment.
Nerve root type
Neck pain with upper limb radiating pain, aggravated by forward flexion or backward extension of the neck, decreased sensation in the distribution area of the skin segment of the compressed nerve root, abnormal tendon reflexes, muscle atrophy, decreased muscle strength, limited neck movement, positive pull test and head press test. The cervical spine X-ray showed vertebral body hyperplasia, hook joint hyperplasia, narrowing of the intervertebral space and narrowing of the intervertebral foramen.
1.3 Inclusion criteria
1) Those who met the diagnostic criteria for cervical spondylosis and whose pathology was cervical or neurogenic; 2) Those who were between 25 and 75 years of age.
1.4 Exclusion criteria
(1) those who were under 25 years of age or over 75 years of age; (2) those with vertebral artery type, sympathetic type, spinal cord type and mixed cervical spondylosis, thoracic outlet syndrome, frozen shoulder, carpal tunnel syndrome, etc.; (3) those with normal transverse diameter of intervertebral foramen on X-ray, or those with very serious osteophytes and bone bridges on X-ray; (4) those with congenital deformity or scoliosis deformity, bone tumor or tuberculosis, hypertension, coronary heart disease and other Serious visceral diseases.
1.5 Exclusion criteria
(1) those who are naturally discharged during observation; (2) those who are effectively treated with the treatment method, but the patient adopts other treatment methods or takes other drugs to improve the efficacy, and the efficacy cannot be judged; (3) those whose final diagnosis is not in accordance with the disease; (4) those who stop treatment or switch to other treatment after more than 2 weeks of ineffective treatment, should be treated as ineffective and should not be excluded.
1.6 Criteria for indications and contraindications
The indications are cervical type and nerve root type cervical spondylosis. Contraindications are those with generalized fever, local skin ulcers on the back of the neck and serious skin bleeding.
2. Treatment methods
2.1 Pure electroacupuncture group
2.1.1 Electro-acupuncture treatment
The main acupuncture point is C3-7, and the supporting points are shoulder well, Quchi and Waiguan. After routine disinfection of the acupuncture points, the cervical acupuncture point was selected as 0.30 mm×50 mm milli-needle and stabbed obliquely in the direction of the spine, so that the tip of the needle reached the periosteum of the vertebral plate, and the twisting and twisting method was applied to make the patient slightly distended and numb, and then the G6805-2 electro-acupuncture instrument was applied to the same side for 15 min, and the continuous wave was selected, the frequency was adjusted to 1 gear, and the intensity was adjusted to slightly see the local muscle throbbing, and the patient felt comfortable. The patient felt comfortable. The acupuncture points were acupunctured according to the conventional method, and the acupuncture points were retained for 15 min after obtaining Qi.
2.1.2 Cupping treatment
After the needle is removed, cupping is applied to the back of the neck for 10 min, and the treatment is given once every other day (3 times a week). 10 times is a course of treatment.
2.1.3 Behavioral intervention methods
① Appropriate neck activity. Under a relaxed condition, do the head-up movement, i.e., slowly turn the head as far backward as possible, and feel a slight soreness and swelling in the neck and upper scapula, once every half hour for 1-2 min. ② Lie on your back without a pillow (or low pillow). Sleep position as far as possible to use supine position without pillows or low pillows. If you use a pillow, you can choose a soft material such as the size of the palm of your hand, pad in the neck, do not pad in the pillow.
2.2 Electro-acupuncture and water-acupuncture group
The acupuncture method and electro-acupuncture treatment, cupping method, behavioral interventions are the same as the simple electro-acupuncture group.
The acupuncture points for the water acupuncture treatment were the points or pressure points of the diseased cervical spine suggested by X-ray radiographs, usually the C5 or C6 acupuncture points. The patient was placed in a prone position, and the skin of the acupuncture point was disinfected routinely, then a 5 mL syringe with a dental needle No. 6 was used to extract 4 mL of Danshen injection, and the needle was inserted into the acupuncture point with the painless rapid needle method, and the needle was slowly advanced or lifted up and down until a feeling of air was obtained, 10 times for a course of treatment.
2.3 Warm needle and water needle group
The main acupuncture point of cervical spine was treated with warm acupuncture, and the patient was placed in prone position. The treatment was carried out once every other day (3 times per week), and 10 times was considered as a course of treatment.
2.4 Drug control group
The rheumatic pain capsule was given 7.5 mg orally once a day and 6 capsules in 3 times a day. 1 month was a course of treatment.
3, Treatment effect
3.1 Clinical symptoms and signs score method[2]
① Pain in the neck and arm. Severe pain in the neck and arm, unbearable at night (3 points); moderate pain in the neck and arm, affecting work and life (2 points); mild pain in the neck and arm (1 point); normal (0 points).
② arm and hand numbness. Significant electrical-like numbness that does not decrease (3 points); numbness that does not decrease, but to a lesser extent (2 points); intermittent numbness, mostly during sleep or morning (1 point); normal (0 points).
③ Functional neck activity. Significant limitation of neck function, posterior extension or lateral flexion less than 15° (3 points), moderate limitation of neck function, posterior extension or lateral flexion less than 30° (2 points), mild limitation of neck function, posterior extension or lateral flexion less than 45° (1 point), normal neck function (0 points).
④ pressure pain at the spinous process of the cervical spine lesion, or at the paraspinal region. Heavy pressure pain with obvious upper limb radiating pain (3 points); heavy pressure pain with no obvious upper limb radiating pain (2 points); pressure pain without upper limb radiating pain (1 point); normal (0 points).
⑤ Intervertebral foraminal crush test. There is obvious upper limb radiating pain or numbness (3 points); there is moderate upper limb radiating pain or numbness (2 points); there is suspicious upper limb radiating pain or numbness (1 point); normal (0 points).
3.2 Efficacy criteria
The patients were judged mainly according to the improvement rate of clinical symptoms and signs points.
Clinical control The symptoms and positive signs basically disappeared, the function of the neck and limbs returned to normal, and the score of symptoms and signs decreased by more than 90%.
Significantly effective The symptoms and positive signs improved significantly, the function of the neck and limbs returned to normal, and the score of symptoms and signs decreased by 70% to 90%.
Effective Symptoms and positive signs improved, cervical limb function improved, and symptom score decreased by 40%-70%.
Ineffective The symptoms and signs did not improve, and the symptom and sign points decreased by less than 40%.
3.3 Treatment results
3.3.1 Comparison of symptom scores of each group before and after treatment
By F test, the scores of each group before treatment were similar, P＞0.05, and the difference was not statistically significant. After 4 weeks, 8 weeks and 4 months of treatment, the scores were compared with those before treatment, and the differences were statistically significant, indicating that both acupuncture treatment and drug treatment for cervical spondylosis were effective. In the score analysis after 4 weeks of treatment, the difference between the acupuncture group and the drug control group was not statistically significant at P > 0.05; in the score analysis after 8 weeks of treatment, the difference was statistically significant at P < 0.05 between the electro-acupuncture group and the electro-acupuncture and water-acupuncture group and the drug control group, indicating that the efficacy of the electro-acupuncture group and the electro-acupuncture and water-acupuncture group was better than that of the drug control group; in the score analysis after 4 months of follow-up or treatment, the difference was statistically significant between the warm acupuncture group and the drug control group. The difference was statistically significant when comparing the warm acupuncture and water acupuncture groups with the drug control group; while the difference was statistically significant when comparing the simple electro-acupuncture and electro-acupuncture and water acupuncture groups with the drug control group.