Spondylopathy ( Spinal Degeneration )

 

In a study group, 8 cases of lumbar spondylopathy, including spondylolisthesis, spondylosis and osteoporosis, were treated by Acupoint Injection Therapy (AIT) -- Chinese herbs and Vitamins injected directly into acupuncture points (Huatuojiaji and back-shu points) from the first to the fifth lumbar vertebrae. Another 6 cases of lumbar spondylopathy were treated by conventional acupuncture as the controls. The results showed that treatment by AIT at the Huatuojiaji points and back-shu points was superior in analgesic effect and total clinical effective rate as compared to conventional acupuncture. In this study group, an additional 3 cases showed significant improvement from X-rays after three months (about 90 treatments). However, in the control group, not one case showed a significant change in the X-rays.

CLINICAL DATA
Among the 14 cases in this series, 7 cases were male and 7 female ranging in age from 45 to 61 years old, with an average age of 53 years. The shortest duration of illness was 2 years, and the longest 11 years. The patients were divided into two groups (patients chose which treatment they wanted by themselves) according to the present pain intensity (PP). 8 cases were in the treatment group (AIT). 6 cases were in the control group (conventional acupuncture alone). There was no significant difference in age and duration of illness between the two groups. The patients were suffering from prolapse of lumbar intervertebral disc, lumbar muscular fibrositis, lumbar muscle strain, spondylolisthesis, spondylosis and generalized osteoporosis. Patients whose lumbago was due to kidney and gynecological disease, and those who could not stick to the treatment, were excluded.

DIAGNOSTIC CRITERIA
1. Pain in the unilateral or bilateral lumbar region radiating to the posteriolateral part of the leg above the knee joint level in severe cases, but not exacerbated by increased the abdominal pressure.
2. Unable to sit and stand for long, with pain exacerbated after tiredness and alleviated after rest.
3. X-rays show degenerative changes and tension, or spasm of the muscle.
4. On palpation, there is a tubercular or cord-like mass.
5. Erythrocyte sedimentation rate, antistreptolysin O test, and rheumatoid factors are normal.

METHOD OF TREATMENT
For the AIT treatment group, bilateral Huatuojiaji points (Extra) and back-shu points (BL22, 23, 24, 25) from the first to fifth lumbar vertebrae, we took turns in selecting the main points and the tenderness points. Leg, hand, and even abdominal points were selected as the auxiliary points. Specific Chinese herbs (such as Dang Gui, Xia Tien Wu, Yia Mu Guar, etc.) & Vitamins (such as Vitamin B1, B12 , Bco, and Vitamin C ) were injected by hypodermic syringe into case-specific points.

For the control group, the acupuncture needles were inserted perpendicularly into the same points. After insertion, the needles were slowly twirled till the needling sensation transmitted towards the lumbar transverse process. Needles were perpendicularly inserted into points to a depth of 0.5-l.0 cun. The adjunct points were also stimulated in different ways in different groups.

The treatment was given once daily, 10 sessions constituting one course of treatment, with a 1-day interval between courses -- 30 sessions with 3 days off for 3 months.

CRITERIA FOR THERAPEUTIC EFFECT
The McGill Pain Questionnaire (MPQ) was adopted for comprehensive evaluation.
COMPLETELY CURED:
All clinical symptoms and signs disappeared. The functional movement became normal and/or the X-rays improved to 100%.
MARKEDLY EFFECTIVE:
All clinical symptoms and signs basically disappeared, regaining normal functional movement, and/or the X-rays improved significantly.
EFFECTIVE:
Clinical symptoms were alleviated, with improved functional improvement and unchanged signs.
INEFFECTIVE:
No obvious improvement.

THERAPEUTIC RESULTS:
Comparison of the analgesic effects between the two groups (see Table1):
Table 1. A comparison of the Difference in Pain Integration Before and After Treatment Between the Two Groups:

Index	Treatment group(n=8)	Control group(n=6)
Positive item number in selection of words	2.53 +/- 0.72**	1.42 +/- 0.24
Sensory score of pain rating index	3.09 +/- 0.97**	1.74 +/- 0.68
Emotional score of pain rating index	1.25 +/- 0.23	1.39 +/- 0.31
Total score of pain rating index	5.45 +/- 1.55*	4.24 +/- 1.41
Visual analogue score (cm	3.76 +/- 1.00**	2.31 +/- 0.61
Present Pain intensity	1.72 +/- 0.41**	0.02 +/- 0.03

* P<0.05, ** P<0.0l, compared with the control group

As shown in Table 1, the differences in every index, except the emotional score of pain rating index, between the treatment and control groups, were significant or very significant (P<0.05 or P<0.0l), indicating that AIT at the Huatuojiaji or back-shu points was superior in analgesic effect to the control group.

A comparison of the therapeutic effects in treatment of the third lumbar transverse process syndrome between the two groups is listed in Table 2.

Table 2. Comparison of Therapeutic Effects between the Two Groups

Group	Cured	Markedly effective	Effective	Ineffective	Total effective rate
Treatment group(n=8)	5 (62.5%)	2 (25.0%)	1 (12.5%)	0	100%
Control group(n=6)	3(50.0%)	1(16.7%)	1(16.7%)	1(16.7%)	83.4%

Comparison of the total effective rate between the two groups, x 2=5.3, P<0.05
As shown in Table 2, the total effective rate in the treatment group was significantly higher than in the control group.

DISCUSSION:
This kind of spinal problem comes from the chronic retrograde in the joint cartilage and the degenerative strain in the surrounding soft tissues, which results in irritating symptoms by pressing on the nerve root and blood vessels. This is due to a lack of sufficient blood circulation to supply nutrition to the spine and soft tissue, which causes spondylopathy, such as spondylolisthesis, spondylosis , osteoporosis, and other degenerative changes.
Transverse processes of the lumbar vertebra are the most vulnerable when the muscles and fasciae connected with the transverse processes are pulled, contracted suddenly, or have abnormal loading. This may lead to laceration, hemorrhage, and hematoma on the area connecting the muscles with the transverse processes, which is followed by muscular tension and spasm, and stimulation or compression of the lateral branch of the posterior rams of the spinal nerve, thus resulting in pain in the region of the transverse processes, buttock, and thigh. The lumbar transverse process syndrome is a common disease in patients with lumbago or lumbocrural pain. Its pathogenesis is related to the anatomical and physiological characteristics of the lumbar vertebra, which is in the middle of the physiological lordosis of the lumbar vertebrae, serving as an axis of movement of the lumbar region. Therefore, the traction stress borne by both of its transverse processes is the strongest among the lumbar vertebrae. In addition, the transverse processes of the lumbar vertebra are the longest among all the transverse processes of the lumbar vertebrae. The lever effect on the transverse processes of the lumbar vertebra is the strongest. Pulling forces borne by the ligaments, muscles, fasciae, and aponeuroses adhered to the transverse processes are the strongest as well.
Physiotherapy, or even conventional acupuncture produces poor therapeutic results and needs long term treatment to prevent from getting worse. It is very difficult to see any regenerative changes. We use AIT with certain Chinese herbs and Vitamins to raise the effective rate.
1. Acupuncture points on the back (Huatuojiaji points and Back -shu points), especially the points located in the affected area were selected as the main acupoints, while the Ashi point and points on the leg, hand, and even abdominal area were the auxiliary points.
2. A small dose of Chinese herbs and Vitamins performed the stimulating role instead of acupuncture needles. Some points were injected with Chinese herbs, such as Radix Angelica Sinensis, Radix Salviae Mitrorrhizae, while other points were injected with Vitamins, such as Vitamin B1, B12, and C.
3. The purpose of AIT is to primarily stimulate the back points to produce the strong analgesic effects in a safe way. Secondly, AIT improves the micro-circulation in the diseased area by promoting nutrition and oxygen to that area and strengthening the muscles and surrounding soft tissue to support the spine.
All of these factors contribute to the satisfactory results.
In our clinical practice, some patients with the syndrome were treated by AIT alone, with a small dosage of Chinese herbs and Vitamins at the Huatuojiaji points. Satisfactory effects were also obtained with a rapid analgesic effect, which showed that stimulation of the trunk of the posterior ramus of the spinal nerve positively contributed to nonspecific lumbago. However, there was an obvious pathologic change in the patients. Accordingly, we selected the local Ashi tenderness points to enhance the therapeutic effect. The present study showed that instant and satisfactory therapeutic effects were features of this therapy, with both the principal and secondary aspects of the disease treated simultaneously. It was superior to conventional acupuncture alone.
Some studies found through clinical and anatomical research that mechanical stimulation of the trunk of the posterior ramus of the lumbar nerve was the most common cause of nonspecific lumbago. It was also found that the lumbago could be relieved by freezing of the posterior ramus of the spinal nerve. The superior clunial nerves come out of the intervertebral foramens of the first, second, and third lumbar vertebrae, then pass through transverse ligaments and bone interfibrous foramen, running along the dorsal aspects of the first, second, and third lumbar transverse processes and close to the periosteum. Then they go through the intertransverse sulci and pierce the muscles originating from the transverse processes to their dorsal parts. The superior clunial nerve is easily injured where it passes the root segment of the lumbar transverse processes.
Other researchers have determined the pulling force borne by the posterior ramus of the spinal nerves in a three-dimensional movement of the lumbar vertebrae in a fresh corpse. It was found that the stress on its trunk was the strongest, and the trunk was the most vulnerable. The pulling force borne by one pair of the posterior ramus of the second lumbar nerves was the strongest among five pairs of posterior ramus of the lumbar nerves. Injury is probable where it passes the root segment of the third lumbar transverse processes. These findings tally with the fact that there is tenderness over the area of the third lumbar transverse process in most of the patients with nonspecific lumbago. In the light of these findings, it is possible that the lateral branches of the posterior ramus of the second and third lumbar nerves pass the third lumbar transverse processes. Thereby, pain in the region of the third lumbar transverse processes may result if their trunks are stimulated. Therefore, we treated the third lumbar transverse process syndrome with AIT, using a small dose of Chinese herbs and Vitamins at the Huatuojiaji points from the first to the fifth lumbar vertebra with satisfactory effects. This results from the needling sensation radiating to the pain area and drugs (herbs and Vitamins) to prolong the stimulating effects.

CONCLUSIONS:
The results of this Pilot Study indicate that Acupoint Injection Therapy (AIT) is a safe and effective therapy for patients with degenerative spondylopathy, and thus offers itself as a viable option for the kind of patient who refuses conventional therapy (long-term oral pain killers or an operation): especially for patients who have no response to or who suffer the negative side effects from pain-killers or an operation. However, further research is necessary to prove the effectiveness of this treatment on a large scale. We suggest that AIT deserves further evaluation in larger and longer clinical trials. We are prepared to conduct further research to compare AIT with conventional therapy.

Have a look Spinal Degeneration(Spondylopathy) 1 , Spondylopathy 2, Degenerative Change and Compression Fracture of Lumbar spine