Clinical Research Of Abdominal Acupuncture Combined With Mckenzie Therapy On The Neck Type Cervical Spondylosis

Background:Cervical spondylosis has all sorts of signs and symptoms caused by the stimulation or stress on the neighboring tissues with the degeneration of the cervical intervertebral disc itself and its secondary change. In the classifications the cervical spondylosis, the neck type is one of the most common types, accounting for about40%to60%, and often happened in women aged30to40. Neck type cervical spondylosis is the initial stage and the basic complication of the cervical spondylosis, accompanying with other types of cervical spondylosis. With the main neck symptoms, neck type cervical spondylosis shows paresthesia such as discomfort, pain, numbness of the neck, shoulder and occipital, with corresponding pressure point and neck rigidity. It often comes on the night or morning, eases naturally, and may repeated attacks. With the development of science and technology, the changing of modern work and life pattern, long time work bending over a table, lack of exercise and not straight sleeping posture lead to increasing incidence and younger onset age of neck type cervical spondylosis. In clinical treatment, for treating symptom for urgency, pain relief is particularly important, secondly the functional exercise is needed to restore the daily function. In principle neck type cervical spondylosis needn’t surgery, so the main treatment method is nonsurgical conservative therapy, including Tuina, acupuncture, traction, drug therapy, physical therapy, and the combination therapy.Bo’s abdominal acupuncture therapy is a control system theory with CV8as the core, and treats clinical symptoms of cervical spondylos by needling the abdomen acupuncture meridian, regulating Zang and Fu’s function of transporting the essence, qi and blood. With less acupoint selection, simple operation, abdominal acupuncture therapy treating neck type cervical spondylosis has been widely used in clinic. However, the higher recurrence rate of neck type cervical spondylosis, more neglect of early recurrence symptoms in patients, and less timely and regular treatment leads to recurrence, aggravation and further development to other types of cervical spondylosis, which affect the patients’life work. So, at the same time with acupuncture treatment, functional exercise methods, which could be continued after the treatment in medical institutions, should be chosen to relieve symptoms, reduce the recurrence and the further development of the disease.Consequently, in view of the pain of head and neck shoulder in the neck type cervical spondylosis, this clinical observed certain samples to confirm the therapeutic effect of Bo’s abdominal acupuncture combined with McKenzie therapy on alleviating pain, improving the blood circulation of the neck, relieving the neck and shoulder muscle cramps and other symptoms. This will provides clinical evidence for treating neck type cervical spondylosis with abdominal acupuncture combined with McKenzie therapy, and choice basis for non-surgical treatment optimization formulation.Objective: 1. To systematically summarize all the literatures about the neck type cervical spondylosis to analyze its general situation about the scope, category, epidemiological characteristics, pathogenesis, clinical diagnosis and treatment in both of Western medicine and TCM.2. A bibliometric analyses is conducted to summarize the current hot research direction, the main treatment methods and the rules of selecting points in treatment of neck type cervical spondylosis with acupuncture, then to initially establish a database about the therapeutic methods and the points which could be selected for neck type cervical spondylosis for the clinical doctors3. Observe the pain relief, symptom improvement, function improvement and relapse after treatment in patients with different intervention, such as abdominal acupuncture alone, McKenzie therapy alone and abdominal acupuncture combined with McKenzie therapy.4. To find a better therapeutic regimen for treating the lumbar intervertebral disc herniation in clinic.Methods:1. Literature research:After retrieving the Chinese journal full-text database, the VIP Chinese Journal database, Wanfang Database (including the Chinese medical association journal) and pubmed etc and screening relevant literatures, we analysis the understanding, research and clinical progress about neck type cervical spondylosis in West medicine and traditional Chinese medicine, and summarize the main research techniques, therapeutic methods and rules of selecting points.2. Clinical research:90neck type cervical spondylosis patients were strictly collected according to the diagnostic criteria, inclusion criteria and exclusion criteria, and were randomized into3groups as group A, B, C, with30patients in each group. Patients in group A accepted McKenzie therapy, group B abdominal acupuncture, and group C abdominal acupuncture combined with McKenzie therapy. Abdominal acupuncture chose RN12, PC6, KI17and ST24as the main acupoimts, while McKenzie therapy included5movements. The patients were treated once a day, and continuous5days as a course,2course of treatment with2days interval were observed. The short-form of McGill scale and the cervical functional assessment before and after treatment were evaluated. The main indicators included:analgesic effect, the clinical curative effect, the severity of disease before and after the treatment, the total score of the short-form of McGill scale and PRI, VAS and PPI projects score changes before and after treatment, the total score of the cervical functional assessment and clinical symptoms, clinical signs, daily life action item score changes before and after treatment, adverse events occurred in the process of treatment, follow-up recurrence after treatment and so on. All data analysis were performed using the software SPSS13.0by specially-assigned person.Results:1. Results of literature research:(1) Results of bibliometric analysis:The number of the reported literatures about treatment for neck type cervical spondylosis with acupuncture increased year by year. The researches are mainly carried out in hospitals located in Guangdong(21.2%), Fujian(8.3%) and Shandong(7.1%). The literatures are principally published in statistical source magazines of traditional Chinese medicine and the most reported research type is about the prevention and control measures(87.8%) which mainly adopt acupuncture needle(49%), comprehensive methods of Chinese traditional medicine(48.2%) and combined therapy of Chinese and Western medicine(2.8%).(2) The research result of rules of selecting points:Acupoints in treatment of neck type cervical spondylosis are selected according to the meridians and local pain points. The most used meridians are the Bladder Meridian of Foot-Taiyang(16.62%), the Gallbladder Meridian of foot-Shaoyang(13.47%), the Small Intestine Meridian of Hand-Taiyang(11.46%) and governor meridian(6.88%) while the selected acupoints are distributed among the fourteen meridians and extra nerve points. The most frequently selected acupoints are cervical EX-B2(15.85%), GB20(15.28%), BL10(12.80%) and ashi point(10.37%), and the adjunct acupoints are used depending on different syndromes to improve the symptom and treat effectively.2. Results of clinical research:(1) Results of the baseline index:There were no significant differences from the gender composition, the aging, the course and the severity of disease among the3groups (P>0.05), so the indexes of the3groups could be compared.(2) Comparison of the clinical effect①Result of analgesic effect:The total analgesic effective rate of3groups was63.3%,96.7%and100%respectively, the difference among groups is significant(P<0.001). Comparison between the two groups showed that, there were significant differences between group A and B, between group A and C,(P<0.001). It meant the analgesic effect of McKenzie therapy was significantly lower than abdominal acupuncture and abdominal acupuncture combined with McKenzie therapy. While, there was no statistical difference between group B and C (P=0.829), as the analgesic effect of abdominal acupuncture and abdominal acupuncture combined with McKenzie therapy was nearly.②Result of clinical efficacy:The total clinical effective rate of3groups was83.3%,93.3%and100.0%respectively, the difference among groups is significant(P=0.024). Comparison between the two groups showed that, there were statistical differences between group A and C (P=0.024). It meant the clinical efficacy of abdominal acupuncture combined with McKenzie therapy was significantly better than McKenzie therapy.(3) Comparison of observational indexes before and after treatment①Result of the severity of disease:Intra-group comparison showed the severity of disease after treatment had improved significantly in all3groups versus before treatment (P<0.001). Inter-group comparison showed significant difference among3group after treatment (P<0.05), but not before treatment. Comparison between the two groups showed that, the severity of disease of abdominal acupuncture and abdominal acupuncture combined with McKenzie therapy was significantly lower than McKenzie therapy (P<0.05).②Result of the improvement of the short-form of McGill scale:Paired sample T test of intra-group comparison was taken in90patients, the result showed all3therapies could reduce the short-form of McGill scale scores significantly (P<0.05). Covariance analysis of inter-group comparison showed significant difference among3groups on reduction of the short-form of McGill scale scores (P<0.05). The comparison of item scores of the short-form of McGill scale showed that all3therapies could reduce the PRI, VAS and PPI item scores significantly, and the reduction of abdominal acupuncture and abdominal acupuncture combined with McKenzie therapy was significantly better than McKenzie therapy (P<0.05).③Result of the improvement of the cervical functional assessment:Paired sample T test of intra-group comparison showed significant difference among3groups on the total score of the cervical functional assessment and clinical symptoms, clinical signs, daily life action item score before and after treatment (P<0.05). Moreover, the improvement of the cervical functional, clinical symptoms and clinical signs in abdominal acupuncture and abdominal acupuncture combined with McKenzie therapy groups was better than McKenzie therapy group, while the daily life action item among3groups was nearly(P>0.05). (4) Result of the recurrence during3months follow-up after treatment:Following up the healing and improved patients without falling off in each group for3months, we found2recurrence in25patients of group A (with recurrence rate as8.00%),8in26of group B (30.77%), and2in29of group C (6.90%). With Exact probability calculation, there was significant difference among3groups on the recurrence rate (P=0.025), and abdominal acupuncture therapy leaded more recurrence than other2groups.(5) Result of the adverse reactions:There were some adverse reactions, such as pain when needling, feeling faints when needling in both2group with abdominal acupuncture. Two patients felt faints when first needling in abdominal acupuncture group,1in abdominal acupuncture combined with McKenzie therapy group. All3cases improved markedly and continued acupuncture. There was no bleeding, hematoma, banding needle or sticking of needle in both2groups.Conclusions:By systematically summarizing the related literatures in this project, we find that the researches about treatment of neck type cervical spondylosis with acupuncture are increasing year by year and seek out the hot spots and the main methods of prevention and treatment. There are various therapeutic methods and the acupoints selection is according to the meridians and local pain points while the adjunct acupoints are used depending on different syndromes. We preliminary establish a database about therapeutic methods of neck type cervical spondylosis and rules of selecting points for the treatment in clinical.The clinical research data and analysis shows:1. All the abdominal acupuncture therapy, McKenzie therapy and abdominal acupuncture combined with McKenzie therapy can effectively relieve neck and shoulder pain in the neck type cervical spondylosis patients, improve the clinical symptoms and signs, and daily life movements.2. The relief of pain, improvement of clinical symptoms and signs of abdominal acupuncture therapy and abdominal acupuncture combined with McKenzie therapy is superior to McKenzie therapy alone, integrative therapy is better than abdominal acupuncture alone, but no significant advantage.3. The improvement of actions in daily life in integrative therapy group is better than abdominal acupuncture alone, and better than McKenzie therapy alone, but no significant difference.4. McKenzie therapy and integrative therapy are significantly superior to abdominal acupuncture therapy in the long-term effect and prevention of recurrence, but no significant difference between McKenzie therapy and integrative therapy.In conclusion, curative effect on acupuncture treating neck type cervical spondylosis is significantly, but the methods are various and more difficult to standardize. Bo’s abdominal acupuncture combined with McKenzie therapy not only can improve the clinical efficacy, strengthen the analgesia effect, improve the function of cervical vertebrae, prevent disease recurrence, but also has less adverse reactions, low medical costs, unified standard, easy operation and the active participation of patient. Therefore, the therapeutic regimen is suitable for clinical use in prevention and treatment on neck type cervical spondylosis.But there is still some weakness in our clinical research, for example, the small sample size, the position of points, the way of needling, the obedience of patients, the selecting of measuring scale and questionnaire. In the future, we would mend our weakness above, enlarge the sample size and take a further study on mechanism of Bo’s abdominal acupuncture combined with McKenzie therapy treating the neck type cervical spondylosis.