CLINICAL OBSERVATION ON LUMBAR INTERVERTEBRAL DISC HERNIATION TREATED BY TRACTION COMBINED WITH ACUPUNCTURE

Objective: To observe the therapeutic effect of traction combined with acupuncture on lumbar intervertebral disc herniation (LIDH). Methods:Eighty-three patients diagnosed as LIDH were randomly divided into treatment group (n=42)and control group (n=41). In the treatment group, besides lumbar traction, electroacupuncture at Jiaji (EX-B 2, L 3～5), Shenshu (BL 23), Qihai (CV 6), Mingmen (GV 4), Huantiao (GB 30), Chengshan (BL 57) and Yanglingquan (GB 34) was added. In the control group, only lumbar traction was applied. Results: In treatment group, the cure plus markedly effective rate was 80.95% with a total effective rate of 92.86%, while in control group, it was 39.02% with a total effective rate of 80.48%. The therapeutic effect in the treatment group was obviously better than that in the control group (P<0.001). Conclusion: Lumbar traction plus EA can effectively alleviate or even eliminate clinical symptoms and signs of lumbar intervertebral disc herniation.

A Study on Extension－Flexion Dynamic Lumbar Spine Radiographsin Patients with Lumbar Intervertebral Disc Herniation

The study has collected a set of clinical materials such as extension-flexion dynamic lum-bar spine radiographs and computerized x-ray tornography of lumbar spine and quantified physical exami-nation from 32 patients with lumbar intervertebral disc herniation, who had gone through a suocessful con-servative treatment. The collection was conducted twice before and after the treatment. With the help oft-test and linear correlation analysis, the study suggests that extensionflexion radiograph of lumbar spineis of important clinical significance in weighing the clinical state of an individual patient, especially forthose who receive conservative treatment. The study emphasizes that the biomechanical disturbance oflumbar spinal column may be from another important pathological element along with the irritation of thenerve root by herniated disc tissue in the pathomechanics of lumbar disc herniation. There is also somediscussion of the computerized X-ray tomography diagnosis in this study. Above all, the author provides anew angle of viewing the trouble by one of the soul principles of traditional Chinese medicine: concept ofholistics .

Electroacupuncture plus waist-strengthening exercises for herniation of lumbar intervertebral disc

Objective To investigate the clinical efficacy of electroacupuncture plus waist-strengthening exercises in treating herniation of lumbar intervertebral disc. Methods Fifty patients with herniation of lumbar intervertebral disc were treated with eleetroaeupuncture at the points of Shiqizhui （十七椎 EX-B 8）, Yaoyangguan（腰阳关 GV 3）, Huantiao （环跳 GB 30）, Yanglingquan （阳陵泉GB 34） and waist-strengthening exercises. The total scores of general symptoms were evaluated before the treatment and after four months and seven months of treatment to compare the therapeutic effects. Results The total scores of general symptoms after four months and seven months of treatment were 15.30±5.66 and 19.08±4.57 respectively, which were much higher than the score of 7.42±2.20 before the treatment （both P〈0.01 ）, in addition, the score after seven months of treatment was higher than that after four months of treatment. The variation of scores in patients with different types after treatment was statistically significant （P〈0.05）, and the best effect can he seen in the blood stagnation type of patients with herniation of hnnbar intervertebral disc, then less the patients with liver and kidney deficiency type. Conclusion Electroacupuneture plus waist-strengthening exercises has a satisfactory therapeutic effect on herniation of lumbar intervertebral diste, the longer course of treatment is, the beffer therapeutic effect achieved.

Autologous nucleus pulposus transplantation to lumbar 5 dorsal root ganglion after epineurium discission in rats： a modified model of non-compressive lumbar herniated intervertebral disc

Background Nucleus pulposus of intervertebral discs has proinflammatory characteristics that play a key role in neuropathic pain in lumbar herniated intervertebral disc. One of the most commonly used animal models （the traditional model） of non-compressive lumbar herniated intervertebral disc is created by L4-L5 hemilaminectomy and the application of autologous nucleus pulposus to cover the left L4 and L5 nerve roots in rats. However, such procedures have the disadvantages of excessive trauma and low success rate. We proposed a modified model of non-compressive lumbar herniated intervertebral disc in which only the left L5 dorsal root ganglion is exposed and transplanted with autologous nucleus pulposus following incision of epineurium. We aimed to compare the modified model with the traditional one with regard to trauma and success rate. Methods Thirty Sprague-Dawley male rats were randomized into three groups： sham operation group （n=6）, traditional group （n=12）, and modified group （n=12）. The amount of blood loss and operative time for each group were analyzed. The paw withdrawal threshold of the left hind limb to mechanical stimuli and paw withdrawal latency to heat stimuli were examined from the day before surgery to day 35 after surgery. Results Compared with the traditional group, the modified group had shorter operative time, smaller amount of blood loss, and higher success rate （91.7% versus 58.3%, P 〈0.05）. There was no decrease in paw withdrawal latency in any group. The sham operation group had no decrease in postoperative paw withdrawal threshold, whereas the modified and traditional groups had significant reduction in paw withdrawal threshold after surgery （mechanical hyperalgesia）. Conclusions Transplantation of nucleus pulposus onto the L5 dorsal root ganglion following incision of epineurium in rats established an improved animal model of non-compressive lumbar herniated intervertebral disc with less trauma and more stable pain ethology.

Reduction in nerve root compression by the nucleus pulposus after Feng's Spinal Manipulation

Ninety-four patients with lumbar intervertebral disc herniation were enrolled in this study. Of these, 48 were treated with Feng＇s Spinal Manipulation, hot fomentation, and bed rest （treatment group）. The remaining 46 patients were treated with hot fomentation and bed rest only （control group）. After 3 weeks of treatment, clinical parameters including the angle of straight-leg raising, visual analogue scale pain score, and Japanese Orthopaedic Association score for low back pain were improved. The treatment group had significantly better improvement in scores than the control group. Magnetic resonance myelography three-dimensional reconstruction imaging of the vertebral canal demonstrated that filling of the compressed nerve root sleeve with cerebrospinal fluid increased significantly in the treatment group. The diameter of the nerve root sleeve was significantly larger in the treatment group than in the control group. However, the sagittal diameter index of the herniated nucleus pulposus and the angle between the nerve root sleeve and the thecal sac did not change significantly in either the treatment or control groups. The effectiveness of Feng＇s Spinal Manipulation for the treatment of symptoms associated with lumbar intervertebral disc herniation may be attributable to the relief of nerve root compression, without affecting the herniated nucleus pulposus or changing the morphology or position of the nerve root.