The Clinical Study On The Therapy Of Lumbar Intervertebral Disc Herniation By Feng's Spinal Manipulation

Lumbar intervertebral disc herniation(LIDH) is one of the most important and hackneyed reason in the backleg pain.It commonly takes place in the bottom of lumbar region. One the reason of backleg pain and ischialgia maybe is the nerve roots are oppressed by the protruded nucleus pulposus of lumbar intervertebral disk. In the statistical data referred to WHO in 2005, the incidence of discopathy disease rate including lumbar occupies the eighth position in all chronic and refractory deseases in our country.Manipulative treatment is one of the most commonly used way and has satisfied therapeutic effect in non-operation treatment. Through returned protruded nucleus pulposus to the right position and changed its position with nerve root, it relaxes the conglutination of nerve root and region tissue. That is the therapeutic mechanism of most studier supposed. But because of lack of enough objective evidence, this point is not yet be accepted up to day and that has been become the fatal defect of Manipulative treatment.In order to provid the objective index and proof of therapeutic effect for Feng's Spinal Manipulation(FSM) and further illuminate the therapeutic mechanism aboout reliefing the root compression, we made the topic based on《Treatment of soft tissue injury with traditional Chinese and western medicine》written by Feng Tianyou. 80 patients with LIDH were randomly choosed, first oral use Biqi caps and the traditional Chinese medicine ex-use, accompaniment intravenous transfusion (IVT) treatment of traditional Chinese medicine about promoting blood flow. The process is kept on 10 day in order to rule out the interaction of medicine to the effect of Manipulative treatment. After that 34 patients without obviously symptom changed were choosed to therapy 3 weeks by FSM. The angle of straight leg raising(ASLR), visual analogue(VAL) and Japanese orthopaedics lumbodorsal pain score (JOA) were observated before and after Manipulative treatment. The MRI and MRM were checked before and after Manipulative treatment and followed observating the sagittal diameter index number (SI) of protruded nucleus pulposus in MRI axial view, the included angle of nerve sleeve and scleromeninx vesic the diameter of nerve root sheath sleeves.The result discovered the ASLR, VAL and JOA of patients were obviously improved (P <0.01) after the treatmeat by traditional Chinese medicine, but the cure rate olny reached 3.75%. In the patients treatmeat by FSM, compared with before treatmeat, ASLR, VAL and JOA were obviousely better after treatmeat (P <0.01) . In MRM, the engorge of nerve sleeve was decrease, disappear and interruption.But after 3 weeks by treatment of FSM, the MRM showed that the diameter of nerve sleeve obviously increased(P <0.01), but there was no change in SI and the included angle in MRM before and after treatment (P >0.05 ) . We can conclude these results through our study:1,The therapy effect of raditional Chinese medicine was confrmed to be used as a bisal treatment throughout all therapy procedure.But its therapeutic mechanism was not to aim directly at the initiating agent that brings about clinical symptom. So to treat LIDP by the raditional Chinese medicine should be association with other expectant treatment methods.2,The examination of MRM reflected the mechanics relationship of the protruded nucleus pulposus and nerve root. So it provided objective imaging proof for thoroughly removing the root compression by Manipulative treatment (FSM). That can be used the judgment to linical effect and basal study.3,To therapy LIDP by FSM could reach the satisfied effect. Through rectificating the offset of vertebral body and adjusting disequilibrium of the in- an ex-vertebral column, this method can get the curative goal. The key point of gaining effect for FSM is to remove the root compression, instead of obvious change about protruded nucleus pulposus and the shape and location of the nerve root. Rectificating the offset of vertebral body can relieve even remove the root compression by decreasing the internal pressure from the protruded nucleus pulposus, and this can sharply decrease or eliminate the neural functional impairment. Therefore, we should start from changing the biomechanics character of vertebral column,intervertebral disk and protruded nucleus pulposus to further research the effect mechanics.4,The compensatory ability of nerve root for the mechanical pressure is also one of the therapeutic groundwork whether expectant treatment gain the better effect.To sum up, this study further verificated the Feng Tianyou's theory of disequilibrium of the in- an ex-vertebral column and the offset of single(multitude) vertebral dody. In the same time, it provided objective imaging proof for thoroughly removing the root compression by FSM.Meanwhile, this study offer the new idea about therapeutic mechanical by Manipulative treatment from the biomechanics character of vertebral column,intervertebral disk and protruded nucleus pulposus.