Objective： To compare the biomechanical effects between oblique Ban-pulling manipulation and lumbar erection-rotation manipulation in sitting position in treating lumbar intervertebral disc herniation （LIDH）. Meth...Objective： To compare the biomechanical effects between oblique Ban-pulling manipulation and lumbar erection-rotation manipulation in sitting position in treating lumbar intervertebral disc herniation （LIDH）. Methods： A three-dimensional finite element model of L3-S1 was developed to carry out a comparative study between oblique Ban-pulling manipulation and lumbar erection and rotation manipulation in sitting position. The disc protrusion was assumed to be on the rear left of L4 disc, and the manipulations were performed on the right side. The loading process was simulated by two steps, in the first step, only the compression loading was imposed, and in the second step, both the compression loading and axial rotation moment were imposed. The displacement and stress distribution in L4 disc were investigated. Results： The values of stress and displacement in the second step were lower than those in the first step in each manipulation. The stress and displacement differences between the two steps were respectively 1.79 times and 3.03 times larger in oblique Ban-pulling manipulation than those in lumbar erection-rotation manipulation in sitting position. Conclusion： Oblique Ban-pulling manipulation may result in a better biomechanical effect than lumbar erection-rotation manipulation in sitting position for LIDH.展开更多
The benefits of Lever Positioning Manipulation (LPM) in the treatment of lumbar disc herniation have been widely recognized. The emergence of virtual reality (VR) technology in the field of medicine and the successful...The benefits of Lever Positioning Manipulation (LPM) in the treatment of lumbar disc herniation have been widely recognized. The emergence of virtual reality (VR) technology in the field of medicine and the successful application of augmented reality (AR) technology in the field of surgery have brought new thinking to manipulation researchers on the treatment of lumbar disc herniation (LDH) in the era of artificial intelligence (AI). In this study, the development trend and clinical efficacy of VR technology were discussed from the development process of this technology, and the combination of information interaction technology in the field of chiropractic was found from the existing research approach of lever positioning treatment of LDH, in order to provide a useful reference for researchers.展开更多
Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis(DLS).Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was p...Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis(DLS).Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was performed until February 1, 2021, including nine databases. The homogeneity of different studies was summarized using the Review Manager. The quality of studies was determined with the Cochrane risk-of-bias tool.The evidence quality was graded with the Grading of Recommendations, Assessment, Development, and Evaluations approach.Results: A total of 6 studies involving 524 participants were included. The review demonstrated that manipulation has statistically significant improvements for treating DLS according to Japanese Orthopedic Association scores(mean difference, 3.76;95% confidence interval, 2.63 to 4.90;P <.001) and visual analog scale scores(mean difference,-1.50;95% confidence interval,-1.66 to-1.33;P <.001)compared to the control group. One study reported that the difference in the Oswestry Disability Index between the traction group and the combination of manipulation and traction group was statistically significant(P <.05), while another reported that manipulation treatment can significantly improve the lumbar spine rotation angle on X-ray images compared with the baseline data(P <.05). Moreover, the manipulation group(experimental group) had fewer adverse events than the lumbar traction group(control group).Conclusion: Manipulation intervention is more effective and safer for DLS. Nevertheless, large-scale randomized controlled trials are required to confirm the current conclusions.展开更多
Objective:To systematically evaluate the efficacy and safety of Duhuo Jisheng decoction combined with manipulation in the treatment of lumbar disc herniation.Method:We systematically searched 8 databases at home and a...Objective:To systematically evaluate the efficacy and safety of Duhuo Jisheng decoction combined with manipulation in the treatment of lumbar disc herniation.Method:We systematically searched 8 databases at home and abroad.Literature quality of the included studies was evaluated by the bias risk assessment tool of Cochrane collaboration network,and the Meta-analysis was performed by RevMan 5.3 software.Result:A total of 427 related literature were retrieved,and 12 studies were eventually included,involving 1153 patients.All studies were in Chinese.Meta-analysis results showed that the total effective rate of Duhuo Jisheng decoction combined with manipulation in the treatment of LDH was better than that of the control group(RR=1.23,95%CI[1.17,1.29],P<0.00001).Subgroup analysis showed that Duhuo Jisheng decoction combined with manipulation had a more significant effect than conventional treatment(RR=1.34,95%CI[1.20,1.50],P<0.00001),nonsteroidal anti-inflammatory drugs(RR=1.24,95%CI[1.12,1.37],P<0.0001),and Yaotongning capsules(RR=1.19,95%CI[1.10,1.29],P<0.0001).It has obvious advantages in improving VAS scores(MD=-1.19,95%CI-1.19[-1.87,-0.51],P=0.0006),but it has no obvious advantages in improving JOA scores(MD=2.6595%CI[0.06,5.24],P=0.05).In terms of safety,Duhuo Jisheng decoction combined with manipulation treatment reported fewer adverse events.Conclusion:The Duhuo Jisheng decoction combined with manipulation treatment can effectively relieve the clinical symptoms of patients with lumbar disc herniation,with obvious clinical efficacy,and fewer adverse events.But in view of the limitations of clinical studies,there are some limitations in this study,and more studies with high quality of evidence are needed to further confirm its efficacy and safety.展开更多
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...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.展开更多
Objective:To elucidate how spinal manipulative therapy(SMT)exerts its analgesic effects through regulating brain function in lumbar disc herniation(LDH)patients by utilizing resting-state functional magnetic resonance...Objective:To elucidate how spinal manipulative therapy(SMT)exerts its analgesic effects through regulating brain function in lumbar disc herniation(LDH)patients by utilizing resting-state functional magnetic resonance imaging(rs-f MRI).Methods:From September 2021 to September 2023,we enrolled LDH patients(LDH group,n=31)and age-and sex-matched healthy controls(HCs,n=28).LDH group underwent rs-f MRI at 2 distinct time points(TPs):prior to the initiation of SMT(TP1)and subsequent to the completion of the SMT sessions(TP2).SMT was administered once every other day for 30 min per session,totally 14 treatment sessions over a span of 4 weeks.HCs did not receive SMT treatment and underwent only one f MRI scan.Additionally,participants in LDH group completed clinical questionnaires on pain using the Visual Analog Scale(VAS)and the Japanese Orthopedic Association(JOA)score,whereas HCs did not undergo clinical scale assessments.The effects on the brain were jointly characterized using the amplitude of low-frequency fluctuations(ALFF)and regional homogeneity(Re Ho).Correlation analyses were conducted between specific brain regions and clinical scales.Results:Following SMT treatment,pain symptoms in LDH patients were notably alleviated and accompanied by evident activation of effects in the brain.In comparison to TP1,TP2 exhibited the most significant increase in ALFF values for Temporal_Sup_R and the most notable decrease in ALFF values for Paracentral_Lobule_L(voxelwise P<0.005;clusters>30;FDR correction).Additionally,the most substantial enhancement in Re Ho values was observed for the Cuneus_R,while the most prominent reduction was noted for the Olfactory_R(voxelwise P<0.005;clusters>30;FDR correction).Moreover,a comparative analysis revealed that,in contrast to HCs,LDH patients at TP1 exhibited the most significant increase in ALFF values for Temporal_Pole_Sup_L and the most notable decrease in ALFF values for Frontal_Mid_L(voxelwise P<0.005;clusters>30;FDR correction).Furthermore,the most significant enhancement in Re Ho values was observed for Postcentral_L,while the most prominent reduction was identified for Para Hippocampal_L(voxelwise P<0.005;clusters>30;FDR correction).Notably,correlation analysis with clinical scales revealed a robust positive correlation between the Cuneus_R score and the rate of change in the VAS score(r=0.9333,P<0.0001).Conclusions:Long-term chronic lower back pain in patients with LDH manifests significant activation of the"AUN-DMN-S1-SAN"neural circuitry.The visual network,represented by the Cuneus_R,is highly likely to be a key brain network in which the analgesic efficacy of SMT becomes effective in treating LDH patients.(Trial registration No.NCT 06277739)展开更多
BACKGROUND Lumbar disc herniation(LDH)has emerged as one of the most common causes of low back pain.The routine treatment approach involves chemonucleolysis therapy,discectomy by percutaneous endoscopy,and percutaneou...BACKGROUND Lumbar disc herniation(LDH)has emerged as one of the most common causes of low back pain.The routine treatment approach involves chemonucleolysis therapy,discectomy by percutaneous endoscopy,and percutaneous laser disc decompression.Unfortunately,all of these methods carry inherent risk of causing harm to the patient and,as such,there is an unmet but urgent need for an effective and safe noninvasive treatment for LDH.The purpose of this report is to describe a non-invasive method for re-absorption of LDH.CASE SUMMARY A 34-year-old woman was admitted with a complaint of waist pain that she reported as having become acutely aggravated over the past 3 d and accompanied by discomfort in the right lower limb.Her self-reported medical history included persistent postpartum low back pain from 7 years prior.Physical exam showed positivity for neck flexion test(Lindner sign)and supine abdomen test;the straight leg-raising test showed right 60(+)and left 80(-).Findings from standard imaging(magnetic resonance)and collective physical examinations indicated a L5/S1 herniated lumbar disc.Treatment consisted of three-dimensional(balanced regulating)spinal manipulation and acupuncture,upon which the LDH resolved by retraction.CONCLUSION Following L5/S1 herniated lumbar disc diagnosis,three-dimensional(balanced regulating)spinal manipulation combined with acupuncture therapy is an effective treatment.展开更多
Rotatory chiropractic is one of the key manipulations in the treatment of low-er backache. The present paper reports the kinematic changes in the posterior element oflumbar spine during rotatory manipulation, using mo...Rotatory chiropractic is one of the key manipulations in the treatment of low-er backache. The present paper reports the kinematic changes in the posterior element oflumbar spine during rotatory manipulation, using motion segments of lumbar spine fromfresh cadavers as specimens and an electromechanical system for the measurements. Theanalysis of the angle-displacement curve and the load-angle curve reveals that rotatorychiropractic is a kind of complicated 3-D. 6-degree-of-freedom motion. Correctmanipulation may adjust the volume of the nerve root canal and relax the articulation be-tween the upper and lower joint processes so as to relieve the adhesion of the enclosuresin the nerve root canal and relieve the adhesion of the facet joints, and bring aboutimprovement of local circulation and amelioration of symptoms.展开更多
基金supported by Natural Science Foundation of Guangdong Province, China, No. 2014A030313392~~
文摘Objective： To compare the biomechanical effects between oblique Ban-pulling manipulation and lumbar erection-rotation manipulation in sitting position in treating lumbar intervertebral disc herniation （LIDH）. Methods： A three-dimensional finite element model of L3-S1 was developed to carry out a comparative study between oblique Ban-pulling manipulation and lumbar erection and rotation manipulation in sitting position. The disc protrusion was assumed to be on the rear left of L4 disc, and the manipulations were performed on the right side. The loading process was simulated by two steps, in the first step, only the compression loading was imposed, and in the second step, both the compression loading and axial rotation moment were imposed. The displacement and stress distribution in L4 disc were investigated. Results： The values of stress and displacement in the second step were lower than those in the first step in each manipulation. The stress and displacement differences between the two steps were respectively 1.79 times and 3.03 times larger in oblique Ban-pulling manipulation than those in lumbar erection-rotation manipulation in sitting position. Conclusion： Oblique Ban-pulling manipulation may result in a better biomechanical effect than lumbar erection-rotation manipulation in sitting position for LIDH.
基金Supported by Zhoushan Young and Middle-aged Clinical Famous TCM Physician Project in 2024(Zhoushan Finance and Social Security[2024]No.52).
文摘The benefits of Lever Positioning Manipulation (LPM) in the treatment of lumbar disc herniation have been widely recognized. The emergence of virtual reality (VR) technology in the field of medicine and the successful application of augmented reality (AR) technology in the field of surgery have brought new thinking to manipulation researchers on the treatment of lumbar disc herniation (LDH) in the era of artificial intelligence (AI). In this study, the development trend and clinical efficacy of VR technology were discussed from the development process of this technology, and the combination of information interaction technology in the field of chiropractic was found from the existing research approach of lever positioning treatment of LDH, in order to provide a useful reference for researchers.
基金supported by grants from the Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine (ZYYCXTD-C-202003)the China Academy of Chinese Medical Sciences Evidence-based Capacity Improvement Project (ZZ13-024-7)
文摘Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis(DLS).Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was performed until February 1, 2021, including nine databases. The homogeneity of different studies was summarized using the Review Manager. The quality of studies was determined with the Cochrane risk-of-bias tool.The evidence quality was graded with the Grading of Recommendations, Assessment, Development, and Evaluations approach.Results: A total of 6 studies involving 524 participants were included. The review demonstrated that manipulation has statistically significant improvements for treating DLS according to Japanese Orthopedic Association scores(mean difference, 3.76;95% confidence interval, 2.63 to 4.90;P <.001) and visual analog scale scores(mean difference,-1.50;95% confidence interval,-1.66 to-1.33;P <.001)compared to the control group. One study reported that the difference in the Oswestry Disability Index between the traction group and the combination of manipulation and traction group was statistically significant(P <.05), while another reported that manipulation treatment can significantly improve the lumbar spine rotation angle on X-ray images compared with the baseline data(P <.05). Moreover, the manipulation group(experimental group) had fewer adverse events than the lumbar traction group(control group).Conclusion: Manipulation intervention is more effective and safer for DLS. Nevertheless, large-scale randomized controlled trials are required to confirm the current conclusions.
基金Key projects of the national natural science foundation of China(No.81930118)National support program for leading talents in traditional Chinese medicine--"Qi-huang scholars"program+1 种基金Key research projects of the 13th five-year plan of the China academy of Chinese medical sciences(No.ZZ10-022)Jiangxi province postdoctoral subsidy project(No.2018RC13).
文摘Objective:To systematically evaluate the efficacy and safety of Duhuo Jisheng decoction combined with manipulation in the treatment of lumbar disc herniation.Method:We systematically searched 8 databases at home and abroad.Literature quality of the included studies was evaluated by the bias risk assessment tool of Cochrane collaboration network,and the Meta-analysis was performed by RevMan 5.3 software.Result:A total of 427 related literature were retrieved,and 12 studies were eventually included,involving 1153 patients.All studies were in Chinese.Meta-analysis results showed that the total effective rate of Duhuo Jisheng decoction combined with manipulation in the treatment of LDH was better than that of the control group(RR=1.23,95%CI[1.17,1.29],P<0.00001).Subgroup analysis showed that Duhuo Jisheng decoction combined with manipulation had a more significant effect than conventional treatment(RR=1.34,95%CI[1.20,1.50],P<0.00001),nonsteroidal anti-inflammatory drugs(RR=1.24,95%CI[1.12,1.37],P<0.0001),and Yaotongning capsules(RR=1.19,95%CI[1.10,1.29],P<0.0001).It has obvious advantages in improving VAS scores(MD=-1.19,95%CI-1.19[-1.87,-0.51],P=0.0006),but it has no obvious advantages in improving JOA scores(MD=2.6595%CI[0.06,5.24],P=0.05).In terms of safety,Duhuo Jisheng decoction combined with manipulation treatment reported fewer adverse events.Conclusion:The Duhuo Jisheng decoction combined with manipulation treatment can effectively relieve the clinical symptoms of patients with lumbar disc herniation,with obvious clinical efficacy,and fewer adverse events.But in view of the limitations of clinical studies,there are some limitations in this study,and more studies with high quality of evidence are needed to further confirm its efficacy and safety.
基金supported by grants from the Key Topics of China Traditional Chinese Medicine Scientific Research Project,General Logistics Department of Chinese PLA,No.10ZYZ125the Army Medical Science and Technology the125Scientific Research Projects,Chinese PLA,No.AKJ11J004
文摘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.
基金Supported by the General Program of the National Natural Science Foundation of China(No.82274672)the"Pioneer"and"Leading Goose"R&D Program of Zhejiang Province(No.2022C03123)the Scientific Research Project of the Zhejiang Provincial Department of Education(No.Y202351266)。
文摘Objective:To elucidate how spinal manipulative therapy(SMT)exerts its analgesic effects through regulating brain function in lumbar disc herniation(LDH)patients by utilizing resting-state functional magnetic resonance imaging(rs-f MRI).Methods:From September 2021 to September 2023,we enrolled LDH patients(LDH group,n=31)and age-and sex-matched healthy controls(HCs,n=28).LDH group underwent rs-f MRI at 2 distinct time points(TPs):prior to the initiation of SMT(TP1)and subsequent to the completion of the SMT sessions(TP2).SMT was administered once every other day for 30 min per session,totally 14 treatment sessions over a span of 4 weeks.HCs did not receive SMT treatment and underwent only one f MRI scan.Additionally,participants in LDH group completed clinical questionnaires on pain using the Visual Analog Scale(VAS)and the Japanese Orthopedic Association(JOA)score,whereas HCs did not undergo clinical scale assessments.The effects on the brain were jointly characterized using the amplitude of low-frequency fluctuations(ALFF)and regional homogeneity(Re Ho).Correlation analyses were conducted between specific brain regions and clinical scales.Results:Following SMT treatment,pain symptoms in LDH patients were notably alleviated and accompanied by evident activation of effects in the brain.In comparison to TP1,TP2 exhibited the most significant increase in ALFF values for Temporal_Sup_R and the most notable decrease in ALFF values for Paracentral_Lobule_L(voxelwise P<0.005;clusters>30;FDR correction).Additionally,the most substantial enhancement in Re Ho values was observed for the Cuneus_R,while the most prominent reduction was noted for the Olfactory_R(voxelwise P<0.005;clusters>30;FDR correction).Moreover,a comparative analysis revealed that,in contrast to HCs,LDH patients at TP1 exhibited the most significant increase in ALFF values for Temporal_Pole_Sup_L and the most notable decrease in ALFF values for Frontal_Mid_L(voxelwise P<0.005;clusters>30;FDR correction).Furthermore,the most significant enhancement in Re Ho values was observed for Postcentral_L,while the most prominent reduction was identified for Para Hippocampal_L(voxelwise P<0.005;clusters>30;FDR correction).Notably,correlation analysis with clinical scales revealed a robust positive correlation between the Cuneus_R score and the rate of change in the VAS score(r=0.9333,P<0.0001).Conclusions:Long-term chronic lower back pain in patients with LDH manifests significant activation of the"AUN-DMN-S1-SAN"neural circuitry.The visual network,represented by the Cuneus_R,is highly likely to be a key brain network in which the analgesic efficacy of SMT becomes effective in treating LDH patients.(Trial registration No.NCT 06277739)
基金Supported by Major Science and Technology Innovation Projects of Shandong Province,No.2018CXGC1310Natural Foundation of Shandong Province,No.ZR2019MH134+2 种基金Project of Jinan"20 Universities",No.2019GXRC040Shandong Institute of Advanced Technology,Chinese Academy of Sciences,No.YJZX003Collaborative Innovation Center Project of quality Control of traditional Chinese Medicine and Construction of whole Industry chain in Colleges and Universities of Shandong Province,No.CYLXTCX2020-04.
文摘BACKGROUND Lumbar disc herniation(LDH)has emerged as one of the most common causes of low back pain.The routine treatment approach involves chemonucleolysis therapy,discectomy by percutaneous endoscopy,and percutaneous laser disc decompression.Unfortunately,all of these methods carry inherent risk of causing harm to the patient and,as such,there is an unmet but urgent need for an effective and safe noninvasive treatment for LDH.The purpose of this report is to describe a non-invasive method for re-absorption of LDH.CASE SUMMARY A 34-year-old woman was admitted with a complaint of waist pain that she reported as having become acutely aggravated over the past 3 d and accompanied by discomfort in the right lower limb.Her self-reported medical history included persistent postpartum low back pain from 7 years prior.Physical exam showed positivity for neck flexion test(Lindner sign)and supine abdomen test;the straight leg-raising test showed right 60(+)and left 80(-).Findings from standard imaging(magnetic resonance)and collective physical examinations indicated a L5/S1 herniated lumbar disc.Treatment consisted of three-dimensional(balanced regulating)spinal manipulation and acupuncture,upon which the LDH resolved by retraction.CONCLUSION Following L5/S1 herniated lumbar disc diagnosis,three-dimensional(balanced regulating)spinal manipulation combined with acupuncture therapy is an effective treatment.
文摘Rotatory chiropractic is one of the key manipulations in the treatment of low-er backache. The present paper reports the kinematic changes in the posterior element oflumbar spine during rotatory manipulation, using motion segments of lumbar spine fromfresh cadavers as specimens and an electromechanical system for the measurements. Theanalysis of the angle-displacement curve and the load-angle curve reveals that rotatorychiropractic is a kind of complicated 3-D. 6-degree-of-freedom motion. Correctmanipulation may adjust the volume of the nerve root canal and relax the articulation be-tween the upper and lower joint processes so as to relieve the adhesion of the enclosuresin the nerve root canal and relieve the adhesion of the facet joints, and bring aboutimprovement of local circulation and amelioration of symptoms.
