Minimally Invasive Widening of the Facet Joints in Cervical Radiculopathy by Modified Needles： Technical Report

Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects, we devised a new minimally invasive treatment method that widens the facet joints to decompress nerve roots and release the muscle spasm in cervical radiculopathy with acupuncture needles with blunt tip and mini-scalpel, and named it modified acupuncture procedure. MAP （Modified acupuncture procedure） was administered for 37 patients （mean age = 53.1 years, follow-up = 14.2 months） with cervical radiculopathy who did not recover from 4 weeks of nonsurgical treatment. We analyzed clinical outcomes of patients before and after the procedure through VAS （Visual Analogue Scale） and NDI （Neck Disability Index）. On average, patients received 1.4 MAP （modified acupuncture procedures）. The VAS score difference on the day after procedure and at 1 year follow-up was 36.8 ± 26.5 （from 60.1 ± 25.3 at the baseline to 25.3 ± 17.8 at the reading） （P 〈 0.01） and 31.0 ± 30.4 （29.0 ± 21.8 at the reading） respectively. The NDI value dropped by 19.9 ± 18.3 （from 37.2 ± 19.7 at the baseline to 17.2 ± 15.0 at the reading） （P〈 0.01） on 1 year follow up. MAP was found to have clinical efficacy for cervical radiculopathy.

DIAGNOSTIC VALUE OF NERVE ROOT STIMULATION METHOD IN CERVICAL RADICULOPATHY

By means of cervical nerve root stimulation(CRS) method, the amplitudes and latencies of compound motor action potential(CMAP) of brachial biceps and brachial triceps muscles in 41 patients with clinical symptoms and signs of cervical radiculopathy were observed. The amplitudes of CMAPs on the affected side in the patients were obviously lower than on the healthy side and control group, latencies of CMAPs on the affected side were also significantly prolonged. The results showed that CRS was a sensitive method for making a direct determination of proximal nerve roit cinductiin function, and a good aid for diagnosing cervical radiculopathy.

Keyhole Foraminotomy via a Percutaneous Posterior Full-endoscopic Approach for Cervical Radiculopathy:An Advanced Procedure and Clinical Study

Endoscopic cervical foraminotomy is increasingly used for cervical spondylotic radiculopathy(CSR),but there is great concern about radiation exposure because of the heavy dependence of this surgical method on fluoroscopy.The objective of this study was to introduce in detail an advanced surgical technique of keyhole foraminotomy via a percutaneous posterior full-endoscopic approach as a treatment for CSR and investigate its clinical outcomes.We retrospectively reviewed 33 consecutive patients with CSR who underwent keyhole foraminotomy via a percutaneous posterior full-endoscopic approach from October 2015 to April 2017.The patients’general characteristics,including operative time,blood loss,hospital stay,complications,and recurrence,were obtained.Clinical outcomes were evaluated using the visual analogue scale(VAS)for radicular pain,the neck disability index(NDI)for functional assessment,and the modified MacNab criteria for patient satisfaction.All operations were successfully performed(mean operation time,62 min),with no measurable blood loss or severe related complications.The mean follow-up was 25 months.The VAS and NDI scores were significantly improved as compared with those in the preoperative period(preoperative vs.final follow-up:7.6±1.6 vs.3.83±7.34 for VAS,P<0.01;69.5%±10.5%vs.17.54%±13.40%for NDI,P<0.01).Of the 33 patients,32(97.0%)had good-to-excellent global outcomes and all patients obtained symptomatic improvement.In conclusion,keyhole foraminotomy via a percutaneous posterior full-endoscopic approach is an efficient,safe,and feasible procedure for the treatment of CSR.Its simplified single-step blunt incision for localization appears to decrease radiation exposure risks.

Differential diagnosis of cervical radiculopathy and superior pulmonary sulcus tumor

Background The result would be disastrous if the superior pulmonary sulcus tumor （Pancoast tumor） was misdiagnosed as degenerative cervical spine diseases. The aim of this study was to investigate the differential diagnosis methods of cervical radiculopathy and superior pulmonary sulcus tumor. Methods Clinical manifestations, physical, and radiological findings of 10 patients, whose main complaints were radiating shoulder and arm pain and later were diagnosed with superior pulmonary sulcus tumor, were reviewed and compared with those of cervical radiculopathy. Results Superior pulmonary sulcus tumor patients have shorter mean history and fewer complaints of neck pain or limitation of neck movement. Physical examination showed almost normal cervical spine range of motion. Spurling＇s neck compression test was negative in all patients. Anteroposterior cervical radiographs showed the lack of pulmonary air at the top of the affected lung in all cases and first rib encroachment in one case. The diagnosis of superior pulmonary sulcus tumor can be further confirmed by CT and MRI. Conclusions By the method of combination of history, physical examination, and radiological findings, superior pulmonary sulcus tumor can be efficiently differentiated from cervical radiculopathy. Normal motion range of the cervical spine, negative Spurling＇s neck compression test, and the lack of pulmonary air at the top of the affected lung in anteroposterior cervical radiographs should be considered as indications for further chest radiograph examinations.

Randomised Controlled Trial for the Efficacy of Cervical Lateral Glide Mobilisation in the Management of Cervicobrachial Pain

Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninety- nine participants with chronic CP. Participants were randomised to receive either the lateral glide with self-management (n = 49) or self-management alone (n = 50). Four assessments were made (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Change score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and the Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was followed for data analysis. Results: No statistically significant between-group differences were found for pain (using VAS) in the short-term at six weeks (p = 0.52;95% CI -14.72 to 7.44) or long-term at one year (p = 0.37;95% CI -17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p < 0.001). There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide and self-management was twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patients with chronic CP, the addition of a lateral-glide mobilization to a self-management program did not produce improved outcomes and resulted in higher health-care costs.

Clinical practice guidelines of acupuncture-moxibustion for cervical spondylotic radiculopathy

On the basis of relevant literature and evidence, Clinical Practice Guidelines of Acupuncture-moxibust^on .for Cervical 5pondyloffc Radiculopathy has been formulated according to the quality of evidences and by adopting the method of Grades of Recommendations Assessment, Development and Evaluation （GRADE）, in which the objective of guidelines formulation, the scope of application of the guidelines, the principle of acupuncture-moxibustion treatment of cervical spondylotic radiculopathy, the time for intervention and different acupuncture-moxibustion regimens, etc. were specified.

Treatment of 30 patients with cervical spondylotic radiculopathy by acupuncture plus warming-needle moxibustion:a randomized controlled trial

Objective To observe the clinical efficacy of acupuncture plus warming-needle moxibustion for the treatment of cervical spondylotic radiculopathy.Methods Sixty patients with cervical spondylotic radiculopathy were randomly divided into a warming-needle moxibustion group（group A）and an acupuncture group（group B）according to random number table,with thirty cases in each group.For the patients in the group A,Fengchi（风池 GB 20）,Jingjiaji（Jiaji points on the neck）,Dazhui（大椎 GV 14）,Dazhu（大杼 BL 11）,Jugu（巨骨 LI 16）,Tianzong（天宗 SI 11）,Tianliao（天髎 TE 15）,Jianjing（肩井 GB 21） and Hegu（合谷 LI 4） were selected for warming-needle moxibustion.In the group B,Jianliao（肩髎 TE 14）,Jianyu（肩髃 LI 15）,Quchi（曲池 LI 11）,Tianjing（天井 TE 10）,Yangchi（阳池 TE 4）,and Waiguan（外关 TE 5） were selected for acupuncture.Both groups were treated once a day and ten times constituted a course of treatment.Results Compared with the group B,significant differences were observed in the group A after a course of treatment in terms of 20-score scoring for symptoms of cervical spondylotic radiculopathy,VAS scoring and clinical efficacy[16.63±2.31 vs 15.67±2.48,2.36±1.59 vs 3.98±2.32,100%（30/30） vs 86.7%,all P〈0.05].Conclusion Acupuncture plus warming-needle moxibustion can significantly reduce neck pain and improve neck function of patients with cervical spondylotic radiculopathy,which is worthy of clinical application due to its simple manipulation.

Treatment of cervical spondylotic radiculopathy: acupuncture at neck Jiájǐ points and blood-letting puncture with the plum-blossom needle

Objective To observe the therapeutic effect of acupuncture at neck Jiájǐ （EX） points and blood-letting puncture with the plum-blossom needle on cervical spondylotic radiculopathy. Methods Sixty cases of cervical spondylotic radiculopathy were divided into a treatment group and a control group with 30 cases in each group. Acupuncture at neck Jiájǐ （EX） points （Extra） and blood-letting puncture with the plum-blossom needle were adopted for the treatment group. And acupuncture at neck Jiájǐ （EX） points was adopted for the control group. The therapeutic effect, visual analogue scale （VAS） and the numbness score were observed after 2 treatment courses. Results The total effective rate of the treatment group was 86.7% （26/30）, while the rate of the control group was 83.3% （25/30）. Comparison of the differences of the two groups was without statistic significance （P0.05）. The VAS scores of the two groups after treatment were both improved （both P0.01）, but without statistic significance between the two groups （P0.05）. The numbness scores of the two groups after treatment were both better than those before treatment （P0.01）. The therapeutic effect on numbness of the extremities of the treatment group was better than that of the control group （P0.05）. Conclusion Blood-letting puncture with the plum flower needle has a satisfactory effect on treatment of numbness of the extremities of patient with cervical spondylotic radiculopathy.

System evaluation and Meta analysis on clinical effi cacy of heat-sensitive moxibustion in treatment of cervical spondylotic radiculopathy

Objective To systematically evaluate the efficacy of heat-sensitive moxibustion in treatment of cervical spondylotic radiculopathy（CSR）. Methods Chinese National Knowledge Infrastructure（CNKI）, China Biology Medical（CBM） database, Chinese Science and Technology Periodical Database（VIP）, Wan Fang Data, Pubmed and Cochrane Library were retrieved to search the randomized controlled trials（RCT） on heat-sensitive moxibustion in treatment of CSR, and Meta analysis was conducted by applying Rev Man 5.3 software. Results Eventually, 10 papers were included in this study, including 1008 subjects. Meta analysis result showed： the total effective rate of treatment group was higher than that of control group, and the difference was statistically significant [RR=1.13, 95%CI（1.06, 1.21）, Z=3.54, P=0.000 4]; the cure rate of treatment group was higher than that of control group, and the difference was statistically significant [RR=1.80, 95%CI（1.52, 2.13）, Z=6.82, P〈0.000 01]; the improvement of short-form Mc Gill pain questionnaire（SF-MPQ） of treatment group was superior to that of control group, and the difference was statistically significant [MD=–4.44, 95%CI（–6.38,-2.50）, Z=4.49, P〈0.000 01]; visual analogue scale（VAS） of treatment group was lower than that of control group, and the difference was statistically significant [MD=-0.36, 95%CI（-0.50, –0.23）, Z=5.42, P〈0.00001]; and the improvement of interleukin-6（IL-6） of treatment group was superior to that of control group, and the difference was statistically significant [MD=–7.32, 95%CI（-11.49, –3.14）, Z=3.44, P=0.000 6]. Conclusion It is indicated from the Meta analysis result that the clinical efficacy of heat-sensitive moxibustion or acupuncture combined with heat-sensitive moxibustion in treatment of CSR is superior to that of simple acupuncture or traditional suspended moxibustion, providing a new therapeutic method for treatment of CSR. However, the abovementioned conclusion still needs to be confirmed through randomized blind controlled trials with high quality and large sample size since the sample size of included studies was small, and the quality was low.

Comparison of efficacy between electroacupuncture and the combination of collateral bloodletting,cupping,and acupoint application for cervical spondylosis radiculopathy(CRS)

Objective To observe the efficacy of treating young patients with cervical spondylosis radiculopathy （CRS） by collateral bloodletting, cupping, and acupoint application. Methods Sixty-one CRS patients were randomly divided into an acupoint application group （group A, 31 cases） and an electroacupuncture group （group B, 30 cases）. Both sides of the spine and scapula were treated with collateral bloodletting, cupping, and acupoint application over Ashi points in group A. The following points received electroacupuncture in group B： Jiaji （夹脊 EX-B2）, Fengchi （风池 GB 20）, Jianjing （肩井 GB 21）, Jianyu （肩髃 LI 15）, Waiguan （外关 TE 5）, Houxi （后溪 SI 3） and Dazhui （大椎 GV 14）. Patients in the two groups were compared in terms of scores for total symptoms and signs, and the theraputic effect of each method was analyzed. Results Total score of symptoms and signs of the two groups were both more significantly improved compared to that before treatment （9.96 ± 2.02 vs 15.87 ± 1.84, P〈0.05 in group A; 10.02 ± 1.76 vs 13.59 ± 1.52, P〈0.05 in group B）. The differences in two groups before and after treatment were 5.91 ± 1.95 in group A, 3.53 ± 1.68 in group B, they were statistically significant （P〈0.05）. The total effective rate of group A [93.6% （29/31）] was better than that of group B [83.3% （25/30）], and the differences were statistically significant （P〈0.05）. Conclusion Good therapeutic effects can be achieved in treating young CRS patients with collateral bloodletting, cupping, and acupoint application.