[Clinical guidelines for diagnosis and treatment of cervical spondylotic myelopathy with the integrated traditional Chinese and Western medicine(2023)].

The "Clinical Guidelines for Diagnosis and Treatment of Cervical Spondylotic Myelopathy with the Integrated Traditional Chinese and Western Medicine" were formulated by the Orthopedic and Traumatology Professional Committee of the Chinese Association of Integrative Medicine in accordance with the principles of evidence-based medicine and expert consensus, and provide clinicians with academic guidance on clinical diagnosis and treatment of CSM. The main content includes diagnostic points, disease grading assessment, TCM syndrome differentiation, surgical indications and timing, integrated traditional Chinese and Western medicine treatment, and postoperative rehabilitation. This guideline proposes for the first time that the treatment of CSM should follow the principle of grading, clarify the timing and methods of surgical treatment, establish common TCM syndrome differentiation and classification, attach importance to postoperative integrated rehabilitation of Chinese and Western medicine, and strengthen daily follow-up management. It hopes to promote the standardization, effectiveness, and safety of clinical treatment of CSM.

Osteopatía hipertrófica canina: relato de caso / Canine hypertrophic osteopathy: case report

Se presenta el caso de un canino Bóxer de 11 años de edad con osteopatía hipertrófica, proceso patológico óseo de escasa presentación. Se caracteriza por osteofitosis periostales bilaterales a lo largo de las diáfisis de los huesos largos y de las falanges.

A case of a 11 year old Boxer dog with hypertrophic osteopathy is presented. This is an uncommon pathological process characterized by bilaterally symmetric and generalized periosteal proliferative in long bones and falanges.

Apresenta-se o caso de um canino da raça Boxer com 11 anos de idade com osteopatia hipertrófica, processo patológico ósseo considerado incomum, caracterizado por osteofitoses periosteais bilaterais ao longo das diáfises dos ossos longos e das falanges.

Human neuropathological and animal model evidence supporting a role for Fas-mediated apoptosis and inflammation in cervical spondylotic myelopathy.

Although cervical spondylotic myelopathy is a common cause of chronic spinal cord dysfunction in humans, little is known about the molecular mechanisms underlying the progressive neural degeneration characterized by this condition. Based on animal models of cervical spondylotic myelopathy and traumatic spinal cord injury, we hypothesized that Fas-mediated apoptosis and inflammation may play an important role in the pathobiology of human cervical spondylotic myelopathy. We further hypothesized that neutralization of the Fas ligand using a function-blocking antibody would reduce cell death, attenuate inflammation, promote axonal repair and enhance functional neurological outcomes in animal models of cervical spondylotic myelopathy. We examined molecular changes in post-mortem human spinal cord tissue from eight patients with cervical spondylotic myelopathy and four control cases. Complementary studies were conducted using a mouse model of cervical spondylotic myelopathy (twy/twy mice that develop spontaneous cord compression at C2-C3). We observed Fas-mediated apoptosis of neurons and oligodendrocytes and an increase in inflammatory cells in the compressed spinal cords of patients with cervical spondylotic myelopathy. Furthermore, neutralization of Fas ligand with a function-blocking antibody in twy/twy mice reduced neural inflammation at the lesion mediated by macrophages and activated microglia, glial scar formation and caspase-9 activation. It was also associated with increased expression of Bcl-2 and promoted dramatic functional neurological recovery. Our data demonstrate, for the first time in humans, the potential contribution of Fas-mediated cell death and inflammation to the pathobiology of cervical spondylotic myelopathy. Complementary data in a murine model of cervical spondylotic myelopathy further suggest that targeting the Fas death receptor pathway is a viable neuroprotective strategy to attenuate neural degeneration and optimize neurological recovery in cervical spondylotic myelopathy. Our findings highlight the possibility of medical treatments for cervical spondylotic myelopathy that are complementary to surgical decompression.

Terapia manual no tratamento da espondilólise e espondilolistese: revisão de literatura / Manual therapy for treating spondylolysis and spondylolisthesis: a literature review

A espondilólise é um defeito na pars interarticularis da vértebra com descontinuidade óssea do segmento intervertebral; a progressão do defeito resulta em deslizamento de uma vértebra sobre a outra, chamado espondilolistese, o que pode provocar dor. O tratamento não-cirúrgico é a escolha inicial na maioria dos casos de espondilolistese, mas poucos estudos verificam a eficácia dos tratamentos conservadores. O objetivo deste estudo foi realizar uma revisão da literatura sobre esses tratamentos, sobretudo no que concerne à terapia manual, a fim de ajudar os terapeutas na prescrição de intervenções eficazes. Os resultados mostram que tanto a terapia manual como a fisioterapia convencional apresentam efeitos benéficos na redução da dor lombar e na melhora funcional do paciente. As terapias manuais envolvem manipulação da coluna vertebral e articulação sacroilíaca, músculo-energia e alongamento dos músculos afetados. Exercícios de estabilização lombopélvica, fortalecimento dos músculos posturais e alongamento dos isquiotibiais e psoas também foram considerados importantes. O paciente deve ser avaliado individualmente em seu quadro clínico e radiográfico para determinação do plano de tratamento. Dentre as opções conservadoras de tratamento encontradas, nenhuma se mostrou conclusivamente superior às outras e todas podem ser incluídas no tratamento sintomático de pacientes com espondilólise/listese.

Spondylolysis is a defect in the pars interarticularis of a vertebra with a disruption in the intervertebral segment. Progression of the defect leads to one vertebra slipping over another - which is called spondylolisthesis - which may cause low-back pain. Non-surgical treatment is the initial course of action in most cases of spondylolisthesis. However, few studies have assessed the efficacy of conservative treatment. The purpose of the present study is to review literature on conservative treatment for spondylolysis/listhesis, especially manual therapy, in order to guide practitioners for effective intervention. Results show that both manual therapy and conventional physiotherapy were effective in relieving low-back pain and beneficial for patient's functional outcome. Manual therapy involved spine manipulation, sacroiliac joint manipulation, muscle-energy techniques and stretching affected muscles. Stabilizing lombopelvic exercises, postural muscles strengthening, and hamstring and psoas stretching were also considered important in treating spondylolysis/listhesis. Each case's clinical and radiological features must be individually considered in order to determinate therapeutic strategy. Among non-surgical options, none has proved better than others and all may be included in symptomatic treatment of patients with spondylolysis/listhesis.

Zygapophyseal joint adhesions after induced hypomobility.

OBJECTIVE: Adhesions (ADH) have been previously identified in many hypomobile joints, but not in the zygapophyseal (Z) joints of the spine. The objective of this study was to determine if connective tissue ADH developed in lumbar Z joints after induced intervertebral hypomobility (segmental fixation). METHODS: Using an established rat model, 3 contiguous segments (L4, L5, L6) were fixed with specially engineered, surgically implanted, vertebral fixation devices. Z joints of experimental rats (17 rats, 64 Z joints) with 4, 8, 12, or 16 weeks of induced hypomobility were compared with Z joints of age-matched control rats (23 rats, 86 Z joints). Tissue was prepared for brightfield microscopy, examined, and photomicrographed. A standardized grading system identified small, medium, and large ADH and the average numbers of each per joint were calculated. RESULTS: Connective tissue ADH were characterized and their location within Z joints described. Small and medium ADH were found in rats from all study groups. However, large ADH were found only in rats with 8, 12, or 16 weeks of experimentally induced intervertebral hypomobility. Significant differences among study groups were found for small (P < .003), medium (P < .000), and large (P < .000) ADH. The average number of medium and large ADH per joint increased with the length of experimentally induced hypomobility in rats with 8 and 16 weeks of induced hypomobility. CONCLUSIONS: We conclude that hypomobility results in time-dependent ADH development within the Z joints. Such ADH development may have relevance to spinal manipulation, which could theoretically break up Z joint intra-articular ADHs.

[Establishment of a rat model of cervical syndrome with kidney deficiency].

OBJECTIVE: To establish a rat model of cervical syndrome (CS) with kidney deficiency. METHODS: A group of 30 three-month-old female Sprague-Dawley rats were randomly divided into normal control group, CS group and CS with kidney deficiency group (combined group), with 10 rats in each group. Rats in the normal control group received no treatment, rats in the CS group underwent only resection of cervical muscles and ligaments as unbalanced dynamic and static animal model, and rats in combined group underwent resection of both cervical muscles and ovaries as kidney deficiency model. Serum and cervical intervertebral discs were collected. Kidney deficiency was determined by observing the morphologic changes of uterus and appendages, detecting the weight of uterus and appendages and the content of serum estradiol (E(2)). The degeneration of intervertebral discs was determined by detecting the histopathology, the expressions of type II collagen and type X collagen proteins, and the expressions of aggrecan-1 (Agc1), type II procollagen gene (Col2a1), matrix metalloproteinase-13 (MMP-13) and tissue inhibitor of metalloproteinases-1 (TIMP-1) mRNAs. RESULTS: Compared with those in the normal control group and CS group, the rats in the combined group were noted with the uterus atrophied, the caliber of oviduct thinned, the weight of uterus and appendages diminished obviously, the content of serum E(2) decreased, cervical intervertebral disc degenerated more seriously, type II collagen protein expression decreased, type X collagen protein expression increased, Agc1 and Col2a1 mRNA expressions in intervertebral disc decreased, and the MMP-13 mRNA expression increased. CONCLUSION: The rat model of CS with kidney deficiency is established. Kidney deficiency can aggravate cervical intervertebral disc degeneration.

Systematic review and meta-analysis of the efficacy of tuina for cervical spondylosis.

AIMS AND OBJECTIVES: This study performed a meta-analysis of seven parallel-group comparison studies evaluating the efficacy of tuina in treating cervical spondylosis. BACKGROUND: Tuina is a form of Chinese manipulative therapy. It has been used as a modality for the treatment of symptoms associated with such a musculoskeletal condition as cervical spondylosis. However, evidence regarding the efficacy of tuina for cervical spondylosis has yet to be determined. DESIGN: Systematic review. METHODS: Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words: tuina, tuinaology, manual medicine, massotherapy, cervical spondylopathy, cervical spondylosis and cervical vertebrae. Chinese research papers were searched through the Chinese electronic periodical services and Wangfane database. The publication date was limited from 1996-2007. Studies were selected if they were written in English or Chinese, used tuina as a stand-alone modality, used a parallel-group comparison design and explicated raw data regarding symptoms relief. Two independent reviewers reviewed the selected studies based on the evidence rating system of the US Preventive Services Task Force. Studies with an evidence rating of II-2 fair or above were included in this review. RESULTS: The direction of the effect size for the improvement of blood flow velocity of vertebral artery and basilar artery was not consistent across studies. Moreover, the pooled effect size was negligible. No evidence supported that tuina could improve headache and vertigo. A small effect of tuina on the viscosity of blood and plasma was found. CONCLUSION: Based on the results of this systematic review, a definitive conclusion regarding the effects of tuina on cervical spondylosis remains to be determined. RELEVANCE TO CLINICAL PRACTICE: The efficacy of tuina is not supported by parallel-group comparison studies.

[Observation on therapeutic effect of shu-needling therapy as main on cervical spondylosis of nerve root type].

OBJECTIVE: To explore a better method for treatment of cervical spondylosis of nerve root type. METHODS: One hundred and two cases were randomly divided into an observation group and a control group, 51 cases in each group. The observation group were treated with Shu-needling, i. e. the needles were deeply inserted into the cervical vertebrae of corresponding Jiaji (EX-B 2), and the control group were treated with routine needling method. Electroacupuncture was used in the two groups. RESULTS: The cured rate and the total effective rate were 68.6% and 98.0% in the observation group and 47.1% and 84.3% in the control group, with significant differences between the two groups (both P<0.05). CONCLUSION: Shu-needling therapy as main has a better therapeutic effect on cervical spondylosis of nerve root type.

[The evidence-based occupational health paradigm in managing back pain: identifying the problem and evaluation of the decision]. / Il paradigma dell'evidence based occupational health nella gestione della rachialgia in operatori sanitari: dalla formulazione del quesito alla valutazione della decisione.

BACKGROUND: Occupational health professionals must rely on the best available evidence in support of the appropriateness of diagnostic tests and preventive or clinical interventions. This study aims at comparing the decisions made in respect of health care personnel with the decisions made on the basis of the evidence and evaluating the effectiveness of these decisions. MATERIALS AND METHODS: Five female nurses with back problems exposed to health risk mostly associated with patient handling and movement were considered. The diagnostic results and the interventions following the decisions made in 2002 were evaluated and compared with the medical data during the years 2004-2005. To assess health changes occurring after the intervention, an indicator of impact was used. During 2006 the health problems were reviewed by means of the multi-step evidence-based occupational health paradigm: starting from identification of the problem and search for evidence (with a new and validated search string and the database Medline) followed by evaluation of performance. Professional performance was assessed by comparing the medical decisions made in 2002 with the decision supported by the evidence. RESULTS: All the medical decisions were in agreement with the decisions inferred from scientific evidence. Furthermore, all subjects showed an improvement in both perceived and objective health conditions after the intervention, together with increased acceptability of working conditions. CONCLUSION: Given that no gold standard exists and that guidelines for the management of back pain need to be assessed for their effectiveness, this study shows that the occupational health professional should be aware of the availability of up-to-date scientific evidence which can provide appropriate solutions to the commonly encountered problems. This perspective will be a challenge for professionals aware of the need to adopt practices related to the concept of quality in occupational health care.

[Clinical observation on Jiquan (HT 1) for treatment of cervical spondylosis of nerve root type].

OBJECTIVE: To observe acupuncture at Jiquan (HT 1) with different manipulations for improvement of abnormal sensation of the upper limb induced by cervical spondylosis of nerve root type. METHODS: One hundred and seven cases were randomly divided into 3 groups. The lifting-thrusting group (n = 37) were treated with acupuncture at Jiquan (HT 1) with lifting-thrusting manipulation, the twirling group (n = 36) with acupuncture at Jiquan (HT 1) with twirling manipulation and the routine needling group (n = 34) with acupuncture at C4 - T1 Jiaji (EX-B 2), Quchi (LI 11). RESULTS: The total effective rate of 91.9% in the lifting-thrusting group was significantly better than 58.3% in the twirling group (P < 0.005) and 76.5% in the routine needling group (P < 0.05), and the therapeutic effect of the twirling group was similar to that in the routine needling group CP > 0.05). CONCLUSION: Acupuncture at Jiquan (HT 1) with lifting-thrusting manipulation can obviously improve abnormal sensation of the upper limb induced by cervical spondylosis of nerve root type.

[Survey and prospects of mini-acupuncture system therapy for cervical spondylosis].

The article introduces resent 10 years' application survey of ear acupuncture, abdominal acupuncture, scalp acupuncture, hand acupuncture and other mini-acupuncture system therapies in clinical treatment of cervical spondylopathy, finding out that unique advantages and problems of this therapy in treatment of cervical spondylopathy, and it prospects for clinical application of mini-acupuncture system.

[Observation on therapeutic effect of acupuncture at "cervical three points" combined with cake-separated moxibustion on cervical hyperosteogeny].

OBJECTIVE: To compare therapeutic effects of acupuncture at "cervical three points" combined with cake-separated moxibustion and routine acupuncture at Jiaji (EX-B 2) on cervical hyperosteogeny. METHODS: Single blind, randomized and controlled methods were used and 91 cases were divided into an observation group of 46 cases and a control group of 45 cases. The observation group was treated by acupuncture at "cervical three points" combined with cake-separated moxibustion, i.e. acupuncture at Chonggu (EX), Dazhui (GV 14), Taodao (GV 13) and moxibustion at pain points with cake made by Rhizoma Atractylodis Macrocephalae and Radix Paeoniae Alba; the control group was treated with acupuncture at Jiaji (EX-B 2). Changes of sourness and pain of the neck, the shoulder and back, pressure pain and cervical activity scores were used for assessment of therapeutic effects. RESULTS: The markedly cured rate of 76.1% in the observation group was better than 42.2% in the control group (P<0.05). After treatment, the scores of all the items were significantly improved in the two groups (all P<0.05), and the observation group in sourness and pain of the neck, the shoulder and back, and cervical activity were better than the control group (all P<0.05). CONCLUSION: The therapeutic effect of acupuncture at "cervical three points" combined with cake-separated moxibustion on cervical hyperosteogeny is superior to routine acupuncture at Jiaji (EX-B 2).

Observation on therapeutic effect of acupuncture at "cervical three points" combined with cake-separated moxibustion on cervical hyperosteogeny / 中国针灸

<p><b>OBJECTIVE</b>To compare therapeutic effects of acupuncture at "cervical three points" combined with cake-separated moxibustion and routine acupuncture at Jiaji (EX-B 2) on cervical hyperosteogeny.</p><p><b>METHODS</b>Single blind, randomized and controlled methods were used and 91 cases were divided into an observation group of 46 cases and a control group of 45 cases. The observation group was treated by acupuncture at "cervical three points" combined with cake-separated moxibustion, i.e. acupuncture at Chonggu (EX), Dazhui (GV 14), Taodao (GV 13) and moxibustion at pain points with cake made by Rhizoma Atractylodis Macrocephalae and Radix Paeoniae Alba; the control group was treated with acupuncture at Jiaji (EX-B 2). Changes of sourness and pain of the neck, the shoulder and back, pressure pain and cervical activity scores were used for assessment of therapeutic effects.</p><p><b>RESULTS</b>The markedly cured rate of 76.1% in the observation group was better than 42.2% in the control group (P<0.05). After treatment, the scores of all the items were significantly improved in the two groups (all P<0.05), and the observation group in sourness and pain of the neck, the shoulder and back, and cervical activity were better than the control group (all P<0.05).</p><p><b>CONCLUSION</b>The therapeutic effect of acupuncture at "cervical three points" combined with cake-separated moxibustion on cervical hyperosteogeny is superior to routine acupuncture at Jiaji (EX-B 2).</p>

Survey and prospects of mini-acupuncture system therapy for cervical spondylosis / 中国针灸

The article introduces resent 10 years' application survey of ear acupuncture, abdominal acupuncture, scalp acupuncture, hand acupuncture and other mini-acupuncture system therapies in clinical treatment of cervical spondylopathy, finding out that unique advantages and problems of this therapy in treatment of cervical spondylopathy, and it prospects for clinical application of mini-acupuncture system.

Clinical observation on Jiquan (HT 1) for treatment of cervical spondylosis of nerve root type / 中国针灸

<p><b>OBJECTIVE</b>To observe acupuncture at Jiquan (HT 1) with different manipulations for improvement of abnormal sensation of the upper limb induced by cervical spondylosis of nerve root type.</p><p><b>METHODS</b>One hundred and seven cases were randomly divided into 3 groups. The lifting-thrusting group (n = 37) were treated with acupuncture at Jiquan (HT 1) with lifting-thrusting manipulation, the twirling group (n = 36) with acupuncture at Jiquan (HT 1) with twirling manipulation and the routine needling group (n = 34) with acupuncture at C4 - T1 Jiaji (EX-B 2), Quchi (LI 11).</p><p><b>RESULTS</b>The total effective rate of 91.9% in the lifting-thrusting group was significantly better than 58.3% in the twirling group (P < 0.005) and 76.5% in the routine needling group (P < 0.05), and the therapeutic effect of the twirling group was similar to that in the routine needling group CP > 0.05).</p><p><b>CONCLUSION</b>Acupuncture at Jiquan (HT 1) with lifting-thrusting manipulation can obviously improve abnormal sensation of the upper limb induced by cervical spondylosis of nerve root type.</p>

Observation on therapeutic effect of shu-needling therapy as main on cervical spondylosis of nerve root type / 中国针灸

<p><b>OBJECTIVE</b>To explore a better method for treatment of cervical spondylosis of nerve root type.</p><p><b>METHODS</b>One hundred and two cases were randomly divided into an observation group and a control group, 51 cases in each group. The observation group were treated with Shu-needling, i. e. the needles were deeply inserted into the cervical vertebrae of corresponding Jiaji (EX-B 2), and the control group were treated with routine needling method. Electroacupuncture was used in the two groups.</p><p><b>RESULTS</b>The cured rate and the total effective rate were 68.6% and 98.0% in the observation group and 47.1% and 84.3% in the control group, with significant differences between the two groups (both P<0.05).</p><p><b>CONCLUSION</b>Shu-needling therapy as main has a better therapeutic effect on cervical spondylosis of nerve root type.</p>

[Clinical observation on distinctive water-medicine cup therapy for treatment of cervical spondylopathy of cervical type].

OBJECTIVE: To use distinctive water-medicine cup therapy for treatment of cervical spondylopathy of cervical type as a sample to provide a more effective cupping method for clinic. METHODS: One hundred and forty cases were randomly divided into a medicine cup group (n = 47), a water cup group (n = 47) and a empty cup group (n = 46). The medicine cup group were treated by cupping therapy with a self-made medicine cup with 45 degrees C Chinese herb solution; the water cup group were treated with a cup with 45 degrees C water, and the empty cup group with a cup with nothing. Clinical symptoms and signs were observed for comparison of therapeutic effects. RESULTS: Clinically cured was 39 cases, and markedly effective was 8 cases in the medicine cup group; 20 cases were clinically cured, 22 cases were markedly effective and 5 cases were effective in the water cup group; 12 cases were clinically cured, 19 cases were markedly effective and 15 cases were effective in the empty cup group. There were significant differences in the ratio of cases of different therapeutic effects and the difference of pain score before and after treatment between the medicine cup group and the water cup group (P < 0.05), between the water cup group and the empty cup group (P < 0.05), and between the medicine cup group and the empty cup group (P < 0.01). CONCLUSION: The therapeutic effect of the distinctive medicine cup is better than the water cup group, and the water cup group is better than the empty cup group.

[Effects of acupuncture at Dazhui (GV 14) on brain stem auditory evoked potentials in the patient with cervical spondylosis of vertebral artery type].

OBJECTIVE: To study on the mechanism of Dazhui (GV 14) in treatment of cervical spondylosis of vertebral artery type, and to explore the feasibility of regarding hrain stem auditory evoked potential (BAEP) as the objective criterion for assessment of the therapeutic effect. METHODS: Fifty-two cases of cervical spondylosis of vertebral artery type were treated with acupuncture at Dazhui (GV 14), their therapeutic effect and changes of BAEP before and after treatment were investigated. RESULTS: Seventeen cases were cured, 26 cases improved and 9 cases were ineffective, with an effective rate of 82.7%. In BAEP, V PL, I-III IPL, III-V IPL had significant changes after treatment (P < 0.05), with a significant difference between the clinically effective group (cured and improved) as compared with the ineffective group (P < 0.05, P < 0.01). CONCLUSION: Acupuncture at Dazhui (GV 14) improves blood supply of the vertebrabssilar artery, eliminates or alleviates clinical symptoms of cervical spondylosis of vertebral artery type. BAEP can be used as the criterion for assessment of the therapeutic effect.