| Background Cervical spondylosis is the most common type of degenerative disease in urban area.Different comprehensive investigations about cervical spondylosis have been conducted in China.However,inconsistent incidence rate are found.The different incidence rate may be due to variable factors,such as ages,district and occupations.Even though the incidence rate is different,the trend of incidence rate is same.This may be due to increasing longevity,prolonged working hours,live under pressure and the prevalence of electronic devices.In addition,because of bad habits,such as inappropriate sitting and sleeping position and lack of exercise.The trend of cervical spondylosis is increasing among different age group,especially in younger age group.The pathogenic factors and mechanisms of cervical spondylosis are still fine tuning.Since,the amount and degree of movement of cervical are considered to be heaviest and largest throughout the spinal cord.The cervical spine is subjected to stress,accidental injuries.Therefore,cervical spine degeneration begins as early as 20-25 year-old as a result of muscle strain injury.Nowadays,electronic devices become more popular.Prolonged use of computers,smart phone and tablet is known to have side-effects on neck.Although cervical spondylosis is not a critical disease,but cervical spondylosis impedes people’s normal life,work,study.Finally,the quality of life of patients is reduced.Due to the changing environment in work and entertainment,people are inevitably using computers and mobile phones.As a result,the onset age cervical spondylosis is getting younger,no longer proprietary to elder anymore.The main symptom of cervical spondylopathy is neck discomfort,accompanied with head,occipital part,and shoulder and back discomfort.The cervical spondylosis has been clearly defined in three aspects at the 3rd National Symposium on Cervical Spondylosis.1)Degenerative change in cervical intervertebral disc tissue.2)Secondary change in cervical intervertebral disc.3)Pathology changes of cervical intervertebral disc surrounding tissue,as a results of irreversible secondary change.These changes are not only reflected in medical imaging,but also reflected in the clinical manifestations.Cervical type of cervical spondylosis is the earliest type to be discovered and described among cervical spondylosis.It had been believed to be the initial form of other types of cervical spondylosis.At this stage,the physiological curvature of the cervical spine changed.The basic manifestation is the unstable state between the vertebral dices,and accompanied by a minor degree of bone hyperplasia.However,no serious degenerative changes have occurred at this stage.The main clinical manifestation is the restriction of neck mobility.Patients will feel neck and shoulders stiffness,especially under fatigue or maintains the same posture for a long time.If patient take rest or get moderate activities for the neck and shoulder joints at this moment,the symptoms will relief.If appropriate treatment is given,the symptoms will also be relieved quickly.Furthermore,the curative effect and treatment will be shortened accordingly.Conversely,if patient indulge in the treatment,the cervical type of cervical spondylosis quickly develop into other more serious types of cervical spondylosis.The symptoms of cervical type of cervical spondylopathy are relatively non-serious and localized.The symptoms may just happen once.This is the reason why the cervical spondylopathy is easily overlooked and patient cannot get suitable treatment.However,some experts suggested the symptoms of cervical type of cervical spondylopathy can be the indicator of other type of spondylopahty.An effective treatment can prevent severe progression of cervical spondylopathy.A more convenient and effective acupuncture treatment for cervical spondylopathy is needed to explore.An a-shi point is believed a reflection of the pathological situation of the tissue.The ancient Chinese Medicine experts claimed it had prominent treatment effects.The modern medicine suggested it was an aseptic inflammatory area actually.Muscle spasm is an important cause of cervical spondylopathy.Once the cervical muscles are injured,muscle spasm follows.Muscle spasm changes the normal position of the cervical vertebrate and the related tissue,and thus decreases the stability.Canggui exploring manipulation was published in the 《Jinzhen Fu》,which is a one of the integrated acupuncture manipulation technique to promote qi arrival.The main characteristic of this acupuncture technique is able to apply a high-intensity stimulation to the lesion.On one hand this able the needle sensation conducts to more directions,play a role in dredging meridians,improving the local blood circulation and metabolism.On the other hand,it has the advantage of penetration needling,that less puntuncture point is needed.Some experts believed Canggui exploring manipulation can increase the damaged area local vascular permeability,blood and oxygen supply,promote the metabolism and change its pathophysiological condition,even has significant analgesic effect.Objective To compare the clinical effect of Canggui exploring manipulation on a shi points in addition to the common practice group.The clinical effect is evaluated by using a randomized controlled clinical trial.Methods This research recruited 75 cases from the Pok Oi Hospital-Hong Kong Batptist University Chinese Medicine Centre for Training and Research(Ho Man Tin),the Pok Oi Hospital-Hong Kong Batptist University Chinese Medicine Centre for Training and Research(Yau Tsim Mong)and several private clinics of the Hong Kong registered Chinese Medicine Practitioners.Seventy cases completed the research.All cases fit the diagnostic criteria of western and traditional chinese medicine of cervical type of cervical spondylopathy as following.Diagnostic criteria of western medicine: According to the 3rd National Symposium on Cervical Spondylosis in 2008 the cervical spondylosis refers to the degeneration of cervical intervertebral disc and its secondary pathological changes involving structural change of the surrounding tissue(nerve roots,spinal cord,vertebral artery,sympathetic nerve and anterior spinal central artery,etc.),and accompanied with medical imaging matched clinical manifestations.This definition includes four basic contents: cervical intervertebral disc degeneration or intervertebral joint degeneration,involving the surrounding tissue,with corresponding clinical manifestations,and with corresponding medical imaging changes.The clinical features of cervical type of cervical spondylosis are as the following:(1)Pain feeling mainly at posterior occipital,temple,auricle,neck and shoulder,and accompanied with tender point;(2)X ray showed the change of cervical spine curvature and intervertebral joint instability;(3)Flexion-extension lateral x ray or MRI showed vertebral instability and trapezoidal-shaped change;(4)Exclude other external neck diseases(stiff neck,periarthritis,rheumatic myofiberitis,neurasthenia,depression,and other non intervertebral disc degeneration caused shoulder blade pain).Diagnostic criteria of traditional Chinese medicine: With reference to the Chinese Medicine Standard for the Diagnosis and Efficacy issued by the Chinese Medicine Council of People’s Republic China in 1994,the criteria includes:(1)History of chronic strain or trauma;(2)Chronic onset mainly at middle-aged group with age over 40,people require long term bowed down their heads or watching TV and videographer(3)Neck,shoulder blade pain,headache,dizziness,neck stiffness,upper limb numbness;(4)Limited neck mobility,spinous process of cervical intervertebral,upper side scapula tenderness,with touchable taut band,decline upper limb muscle strength and muscle atrophy,positive results at brachial plexus pull and spurling test.(5)Luschkas joint hyperplasia,skewed open mouth odontoid process showed in plain X ray film.Cervical intervertebral physiological curvature straightening,intervertebral space narrowing,bone hyperplasia or ligament calcification showed in lateral X ray film,Foraminal stenosis showed in oblique X ray film.CT and MRI are significant for positioning diagnosis.Written informed consent was obtained from each subject before the study.The patients were randomly divided into 2 groups,which were Canggui exploring manipulation group and common practice group,by using the Doll’s random table for clinical cases.The Canggui exploring manipulation group as the treatment group and the common practice group as the control group.According to the teaching materials 《Acupuncture Therapy》2007,Tianzhu(BL10),Dazhui(GV14)、EX-B2 C4-6,Houxi(SI3)are the major acupoints and less than 5 a-shi points were used on both groups.Patients were divided into 2 groups according to the TCM syndrome differentiation: 1.the meridian blockage type;2.the liver and kidney deficiency type.Fengmen(BL12),Geshu(BL17)and Hegu(LI4)were used in addition to the main acupoints in those belonged to the meridian blockage type.Ganshu(BL18),Shenshu(BL23)and Zusanli(ST26)were used in addition in those belonged to the liver and kidney deficiency type.In the control group,standard acupuncture method is applied on each acupoint with the even reinforcing and reducing manipulation technique.Keep the needles on the acupoints for 30 minutes after De Qi.The same technique and treatment time is applied on the major acupoints in the treatment group.Use Canggui exploring technique on the a-shi points on the treatment group.The acupuncture treatment was done every 2 days.A treatment course consisted 6 treatments.The numerical pain rating scale(NRS),the Short-form Mc Gill Pain Questionnaire-2(SF-MPQ-2),the Northwick Park Pain Questionnaire(NPQ)were used as the observation indicators of pain.The Neck Disability Index(NDI)and the range of motion(ROM)were used as the observation indicators of the cervical spine function.The above observation indicators were checked before the first treatment,after the first treatment,after the 6th treatment and 2 weeks after the 6th treatments.After the 6th treatment,The clinical efficacy was estimated by the Efficacy standard of the cervical spondylopathy which was issued by the State Administration of Traditional Chinese Medicine of PRC.The Chi-squared test was used to investigate attributes data,result expressed as mean ± standard deviation(X ± S).Unpaired t test was used to investigate the relationship of mean of 2 groups.The paired t test was used to investigate different before and after treatment.Rank sum test was used to investigated ordinal data.SPSS 18.0 was used as the statistic calculation tool.Results 1.Randomization and Comparability Seventy-five volunteers were recruited in this randomized case controlled clinical trial.Thirty-eight subjects were allocated to treatment group,and only 35 subjects completed the treatment.The treatment group includes 15 female and 20 male.Thirty-three of them require long term desk job.The youngest was 20 year-old and the oldest was 62 year-old,with average age of 41.40±6.80 years.The shortest clinical progress was 8 months and the longest was 48 months,with an average of 36.77±10.41 months.The NRS score was 5.57 ± 1.42;the SFMPQ-2 score is 44.92±6.03;the NPQ score was 36.07±9.6;the NDI score was39.66±9.32;the ROM score was 11.74±2.28.Thirty-seven subjects were allocated to the control group,and only 35 subjects completed the treatment.The control group includes 21 female and 14 male.Twenty-nine of them require long term desk job.The youngest was 16 year-old and the oldest was 64 year-old,with average age of 40.46 ± 6.54 years.The shortest clinical progress was 6 months and the longest was 52 months,with an average of 35.57 ± 5.58 months.The NRS score was 5.54±1.61;the SF-MPQ-2 score was 45.16±5.60;the NPQ score was 35.95 ±10.16;the NDI score was 38.41±9.28;the ROM score was 11.97±1.97.Randomization was proven by comparing 2 groups in gender,occupation,age,clinical progress,NRS score,SF-MPQ-2 score,NPQ score,NDI score and ROM score.No Significant difference was seen between 2 groups(p>0.05,which means 2 groups were well randomized.2.Treatment results NRS score: The NRS score of treatment group was significantly decreased to 4.18±1.01(p<0.05)after the first treatment.Compared with control group only decreased to 5.59±1.30,it was statistically significant(p<0.05).The NRS scores of both treatment group and control group were both significantly decreased after the sixth treatment(p<0.05).The NRS scores of the treatment group and the control group were 2.23±1.89 and 3.42±0.88,respectively.Treatment group reduced the NRS score more effectively than the control group(p<0.05).Even 2 weeks after completing the treatments,the NRS score of both groups were remain lower than the first treatment score.The score of the treatments group was 3.40±1.72 and that of control group was 3.30±1.89.SF-MPQ-2 score: The SF-MPQ-2 score of the treatment group was significantly decreased to 37.31±7.10(p<0.05)after the first treatment,compared with the 42.20±5.06 of the control group,it was statistically significant(p<0.05).The SF-MPQ-2 score of both treatment group and control group were significantly decreased after the sixth treatment and 2 weeks after the treatments(p<0.05).The SF-MPQ-2 score of the treatment group was 27.24±3.98 and 26.69±3.39 after the sixth treatment and 2 weeks completing the treatments.The scores of control group were 33.83±4.79 and 33.49±6.49 respectively.significantly decreased 40.15% and 25.9%,respectively.The treatment group reduced the SF-MPQ-2 score percentage more effectively than the control group(p<0.05).NPQ score: The NPQ scores of both groups only slightly decreased after the first treatment.The score of the treatment group was 35.08±9.48 and that of the control group were 34.85±9.32,respectively.The NPQ score of both groups were significantly decreased after the sixth treatment(p<0.05)and 2 weeks after completed the treatments.The treatment group maintained bigger differences than control group after the sixth treatment and 2 weeks after completing the sixth treatment(p<0.05).The scores of the treatment group were 29.96±8.08 and 26.02±8.07.The scores of the control group were 31.07±9.00 and 29.32±7.90.NDI score: NDI score percentage of the treatment group decreased to 35.81±7.34 after the first treatment.Compared with the 37.28±11.20 of the control group,it was statistically significant(p<0.05).The NDI score of both treatment group and control group were significantly decreased after the sixth treatment and 2 weeks after the treatments completed(p<0.05).The scores of the treatment group were 24.13±6.78 and 23.72±6.28.The scores of the control group were 26.72±6.78 and 26.21±7.08.There were significantly difference between the groups at those time points.ROM score: The ROM score of treatment group was significantly increased to 13.84±4.49 after the first treatment,compared with the 12.71±6.37,it was statistically significant(p<0.05).The ROM score of both treatment group and control group were increased significantly after the sixth treatment(p<0.05)and 2 weeks after the treatments.The ROM score of the treatment group and the control group were increased to 14.44±2;80 and 13.17±2.18,respectively(p<0.05).Two weeks after completing treatment,the ROM score of the treatment group was 14.49±3.10 while that of the control group was 13.98±4.51.The increase of the ROM scores were statistically significant between 2 groups.Clinical efficacy: After completing the sixth treatment,the treatment group has 2 cases cured,23 conspicuous effective cases,9 effective cases,and 1 non-effective case.The overall effective rate was 97.14%.The control group has 1 case cured,18 conspicuous effective cases,14 effective cases,and 2 non-effective cases.The overall effective rate was 94.9%.According to the results of the rank sum test,there was no statistical difference between the treatment group and the control group,and the effect of the two treatments was similar.Conclusion: Using Canggui exploring manipulation manipulation on a-shi points showed a better analgesic effect than the common practice group according to pain index such as NRS,SF-MPQ-2 and NPQ.This manipulating method also improved the cervical spine function in terms of the range of cervical mobility and NDI.The effects of Canggui exploring manipulation manipulation appear earlier,stronger and last longer.This study had several limitations.Unfortunately there was only 70 subjects complete treatment,even though 75 subjects were recruited.All subjects were recruited from Hong Kong.As noted the regional limitation,results from this study is conflicting with other literature.Another limitation of this is that we did not conduct epidemiological analysis and summarize the characteristics of cervical type of cervical spondylopathy in Hong Kong.All were due to resource limitation.Pain is a subjective feeling;change in scores may not truly reflect the subject’s physical status.Subject with different severity can show their minimal clinically important difference(MCID)by using Neck Pain Scale.Although there was no statistical difference of the overall score of Neck Pain Scale before and after the first treatment,it was observed in the medical records,many subjects reported improved sleeping quality and relieved discomfort at night.In this study we did not further investigate this aspect because of time,manpower and resources limitation.There is no golden standard for accessing cervical spondylosis due to its symptoms complexity.Commonly used scales are including Northwick Park Pain Questionnaire(NPQ),Mc Grill Pain Questionnaire and Neck Disability Index(NDI).Newcastle University used factor analysis to analyze commonly used cervical spondylosis scales.Results showed different factors among the scales.Theoretically,different results will obtain in the same population if different scale is used.However,there is no research working in this aspect.A follow-up comparison of different scales data collected in this study can be conducted.The pathological aspects of cervical spondylosis are neck muscle adhesions and spasm.Nowadays,small knife needle and edge needle therapy are used to release adhesion in cervical spondylosis patient.Constrained by the regulation of Chinese medicine in Hong Kong,the use of special needles such as small knife needles is in a grey area.In this study,traditional micro-needle combining Canggui exploring manipulation obtained similar effects as small knife needle.Furthermore,it would be worthwhile to look at the development of Canggui exploring manipulation in Hong Kong to compensate the restriction of special needle. |
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