Therapeutic Observation of Point-towards-point Electroacupuncture for Cervical Spondylotic Radiculopathy

Wan Bi-jiang, Huang Wei, Zhang Ya-xi, Chen Han-yue, Zhang Huang-sheng

1 Wuhan Hospital of Traditional Chinese Medicine, Wuhan 430051, China

2 Hubei University of Traditional Chinese Medicine, Wuhan 430061, China

3 Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430061, China

CLINICAL STUDY

Therapeutic Observation of Point-towards-point Electroacupuncture for Cervical Spondylotic Radiculopathy

Wan Bi-jiang1, Huang Wei2,3, Zhang Ya-xi1, Chen Han-yue1, Zhang Huang-sheng1

1 Wuhan Hospital of Traditional Chinese Medicine, Wuhan 430051, China

2 Hubei University of Traditional Chinese Medicine, Wuhan 430061, China

3 Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430061, China

Author: Wan Bi-jiang, master of medicine, associate chief physician

Objective: To compare the therapeutic efficacies of point-towards-point electroacupuncture (EA), EA with Jiaji points (EX-B 2), andJing Fu Kangin treating cervical spondylotic radiculopathy (CSR), and to explore the optimal treatment protocol.

Methods: Totally 160 patients with CSR were randomized into three groups: a point-towards-point group (n=60) treated with EA with point-towards-point method; a Jiaji group (n=60) treated with EA at cervical Jiaji (EX-B 2) points; a medicine group (n=40) treated with oral administration ofJing Fu Kangalone. The clinical efficacies were compared afterwards.

Results: After treatment, the recovery rate and total effective rate of the point-towards-point group were significantly better than that of the Jiaji group and medicine group (bothP＜0.01). After 1-week treatment, the symptom and function score of the point-towards-point group was significantly better than that of the Jiaji group and medicine group (bothP＜0.01); the point-towards-point group and Jiaji group both achieved significant improvements in the symptom and function score (P＜0.01,P＜0.05). After 2-week treatment, the three groups all achieved marked improvements in the symptom and function score (P＜0.01). At the end of treatment, in comparing the symptom and function score, the point-towards-point group was significantly different from the medicine group (P＜0.01) and Jiaji group (P＜0.05); the difference between the Jiaji group and medicine group was also statistically significant (P＜0.05).

Conclusion: Point-towards-point EA can rapidly improve the symptoms and function of CSR patients, and it’s superior to EA at Jiaji (EX-B 2) and oral administration ofJing Fu Kangin comparing the clinical efficacy.

Acupuncture Therapy; Electroacupuncture Therapy; Point-towards-point Needling; Radiculopathy; Neck Pain

As a common type of cervical spondylosis (CS), cervical spondylotic radiculopathy (CSR) occupies 50%-60% of the CS patients. People aged 40-60 are often affected. During the recent years, the incidence of CSR has been constantly increasing and the age of onset has become younger and younger, which have severely threatened people’s health condition. From June 2009 to October 2011, we had adopted point-towards-point electroacupuncture (EA) in treating CSR and used the symptom and function scale for CSR invented by the Japanese Orthopaedic Association (JOA)[1]to evaluate the clinical efficacy. We also compared the clinicalefficacies of this method and EA at Jiaji (EX-B 2) points and oral administration ofJing Fu Kang. The report is now given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

It’s in accordance with the diagnostic criteria of CSR form in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[2]. Having a history of chronic trauma or strain, congenital malformation of cervical vertebrae, or degeneration of cervical vertebrae; patients aged over 40 years old and having a long-term deskwork experience; cervical pain, shoulder pain and backache, headache, dizziness, cervical stiffness, numbness of upper limb, and a predilection for stiff neck; limited cervical motion, tenderness at the affected cervical spinal process and the superior-interior angel of scapular on the affected side, muscular nodules, or weakened muscle tension of the upper limb and muscular atrophy, positive Eaton’s test and Spurling’s test; X-ray showing proliferation of uncovertebral joints, open-mouth projection showing oblique odontoid process, lateral projection showing straightened cervical spinal curve, narrowed intervertebral spaces, hyperostosis or calcification of ligaments, and oblique projection revealing smaller intervertebral foramen; CT or MRI is recommended for confirming the diagnosis.

1.2 Inclusion criteria

Conforming to the above diagnostic criteria; age 18-65 years old; having signed the informed consent and finished all requested tests.

1.3 Exclusion criteria

With radiological abnormalities but without symptoms of CS; other types of CS rather than CSR; occiput or atlantoaxial diseases; external humeral epicondylitis, carpal tunnel syndrome, periarthritis of shoulder, bicipital tenosynovitis, thoracic outlet syndrome, etc.; acute intervertebral disc herniation caused by trauma with surgical indications; severe internal conditions such as severe coronary disease and hypertension; weak constitution due to long-term illness, severe neurosis, or pregnant women; fracture, dislocation, tumor, osteoarticular tuberculosis, osteoporosis, or vertebral fusion; conforming to the inclusion criteria but disobeying the treatment protocols, or short of medical materials, affecting the evaluation of the therapeutic efficacy or safety evaluation.

1.4 General data

Totally 160 CSR patients were recruited from the Acupuncture Outpatient of Wuhan Hospital of Traditional Chinese Medicine and Hubei Provincial Hospital of Traditional Chinese Medicine. They were randomized into three groups according to their visiting sequence at 3:3:2, namely, a point-towardspoint group (n=60), a Jiaji group (n=60), and a medicine group (n=40). Finally, 149 subjects finished the whole study, including 58 from the pointtowards-point group, 56 from the Jiaji group, and 35 from the medicine group. The dropped cases occupied less than 10%, which was allowed by the statistical principles. The clinical managements of the three groups are shown in Figure 1. There were no significant differences in comparing the gender, age, and disease duration among the three groups(P＞0.05), indicating the comparability (Table 1).

Figure 1. Clinical management

Table 1. Comparison of the general data

2 Treatment Methods

2.1 Point-towards-point group

Acupoints: Cervical (C4-C7) Jiaji (EX-B 2), Jianwaishu (SI 14), Quyuan (SI 13), Tianzong (SI 11), Naoshu (SI 10), Shousanli (LI 10), and Xialian (LI 8) on the affected side.

Operation: When patient took a sitting position, the to-be-treated acupoints were sterilized using 75% alcohol. With filiform needles of 0.30 mm in diameter and 75 mm in length, Jiaji (EX-B 2) points were punctured by 15° between the needle and skin from C4to C7using point-towards-point method. The needle tip should reach the cervical semispinalis muscle, and the needling sensation should radiate to Quyuan (SI 13); Jianwaishu (SI 14) was punctured toward Quyuan (SI 13), and the needle tip should approach the bone beneath Quyuan (SI 13) and at the superior-interior angle, with the needling sensation radiated to Tianzong (SI 11); Tianzong (SI 11) was punctured toward Naoshu (SI 10) by depth of 2.5 cun, and the needle tip should approach the belly of infraspinatus with needling sensation radiated to the medial upper limb; Shousanli (LI 10) was punctured toward Xialian (LI 8), and the needle tip should reach the extensor carpi radialis brevis muscle with the needling sensation radiated to the lateral forearm. Afterwards, the needles were connected to an EA apparatus (G6805-2), Jiaji (EX-B 2) paired with Jianwaishu (SI 14), Tianzong (SI 11) paired with Shousanli (LI 10), with continuous wave, 2 Hz, and tolerable intensity. The needles were removed quickly after retained for 30 min. The treatment was given once a day, with successive 6-day treatments as a course and 1-day interval between two courses. The therapeutic efficacy was evaluated after 2 treatment courses.

2.2 Jiaji group

Acupoints: Bilateral cervical (C4-C7) Jiaji (EX-B 2).

Operation: The patient took a sitting position. After sterilized by 75% alcohol, the acupoints were punctured perpendicularly with filiform needles of 0.30 mm in diameter and 50 mm in length. The bilateral C4and C7were respectively connected to the EA apparatus (G6805-2) when needling sensation was achieved, with continuous wave, 2 Hz, tolerable intensity. The needles were removed quickly after retained for 30 min. The treatment schedule was same as that in the point-towards-point group.

2.3 Medicine group

The medicine group was prescribed withJing Fu Kang, 5 g each time, twice a day, after dinner. The treatment schedule was same as that in the Jiaji group.

3 Observation of the Therapeutic Efficacies

3.1 Symptom and function scale for CSR

It’s developed based upon the symptom and function scale for CSR by JOA[1], to evaluate the condition from four aspects: symptom and major complaint, working and living abilities, function of hand, and physical sign. One participant was specially assigned to evaluate the scale. The global score was 20 at maximum, the higher the score, the milder the symptom.

3.1.1 Symptom and major complaint

Cervical pain and discomfort: ‘No’ scored 3;‘sometimes’ scored 2; ‘frequently’ scored 1;‘frequently and severe’ scored 0.

Pain and numbness of the upper limb: ‘No’ scored 3;‘sometimes’ scored 2; ‘frequently’ scored 1;‘frequently and severe’ scored 0.

Numbness and pain of fingers: ‘No’ scored 3;‘sometimes’ scored 2; ‘frequently’ scored 1;‘frequently and severe’ scored 0.

3.1.2 Working and living abilities

‘Normal’ scored 3; ‘unsustainable’ scored 2; ‘mild dysfunction’ scored 1; ‘unable to complete’ scored 0.

3.1.3 Function of hand

‘Normal’ scored 0; ‘discomfort but without dysfunction’ scored –1; ‘dysfunction’ scored –2.

3.1.4 Physical sign

Spurling’s test: Negative scored 3; neck and shoulder pain without limitation of cervical motion scored 2; upper limb and finger pain without limitation of cervical motion, or both neck pain and limitation of cervical motion scored 1; upper limb pain, finger pain, and limitation of cervical motion scored 0.

Sensation: Normal sensation scored 2; mild dysfunction scored 1; obvious dysfunction scored 0.

Muscle tension: Normal tension scored 2; mild dysfunction scored 1; obvious dysfunction scored 0.

Tendon reflex: Normal reflex scored 1; reduced or disappeared reflex scored 0.

3.2 Evaluation of therapeutic efficacy

The improvement rate was calculated by using Nimodipine method based on the symptom and function score, and the clinical efficacy was determined according to the improvement rate[3].

Improvement rate ＝ (Post-treatment score －Pre-treatment score) ÷ (20 – Pre-treatment score) × 100%.

Recovery: Improvement rate ≥75%.

Marked effect: Improvement rate 50%-74%.

Improved: Improvement rate 25%-49%.

Invalid: Improvement rate ≤24%.

3.3 Statistical method

The SPSS 16.0 statistical software was adopted for data analyses. The measurement data were expressed bythe intra-group comparisons were analyzed byt-test, and inter-group comparisons were by One-way ANOVA analysis andQ-test. The ranking data were analyzed by usingRiditanalysis.P＜0.05 was considered to have a statistical significance.

3.4 Results

3.4.1 Comparison of clinical efficacies

According toRiditanalysis, there were significant differences in comparing the clinical efficacies among the three groups (P＜0.01). The recovery rate was 69.0% and the total effective rate was 100.0% in the point-towards-point group, versus 39.3% and 91.1% in the Jiaji group, 22.9% and 82.9% in the medicine group, and the differences were statistically significant (P＜0.01). It indicates that the pointtowards-point group has better therapeutic efficacy than the Jiaji and the medicine groups (Table 2).

Table 2. Comparison of therapeutic efficacies (case)

3.4.2 Comparison of the symptom and function score

After 1-week treatment, the symptom and function score was significantly changed in the point-towardspoint group (P＜0.01) and Jiaji group (P＜0.05); the point-towards-point group was significantly better than the Jiaji group and the medicine group in comparing the symptom and function score (P＜0.01). After 2-week treatment, the three groups all had achieved significant changes in the symptom and function score (P＜0.01), and the point-towards-point group was markedly different from the medicine group (P＜0.01) and the Jiaji group (P＜0.05), and the Jiaji group was also significantly different from the medicine group (P＜0.05), (Table 3).

Table 3. Comparison of the symptom and function score (point)

Table 3. Comparison of the symptom and function score (point)

Note: Intra-group comparison with pre-treatment scores, 1) P＜0.01, 2) P＜0.05; compared with the medicine group, 3) P＜0.01, 4) P＜0.05; compared with the Jiaji group, 5) P＜0.01, 6) P＜0.05

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4 Discussion

The modern medicine holds that CSR results from the degeneration of vertebrae due to acute injuries or chronic strains, and the subsequent exudants constantly stimulate the surrounding tissues and lead to aseptic inflammation. When tissue edema and adhesions compress nerves, a series of symptoms will occur[4-8]. While, these factors are reversible, making it possible to treat CS with non-surgical treatments[9]. Acupuncture is effective in treating CSR. Considering the various methods in acupuncture therapy, it’s significant to select the most convenient, easy-to operate, and effective one.

Point-towards-point EA therapy combines pointtowards-point needling method and EA. Cervical Jiaji (EX-B 2) points locate 0.5 cun lateral to the corresponding spinous processes of the cervical vertebrae. When Jiaji (EX-B 2) points were punctured, the needle was inserted from C4toward C7by an angle of 15°. The needle tip should reach the capsule of the zygapophyseal joint (according to individuals, the needling depth is about 50-60 mm), and the needling sensation should radiate to Quyuan (SI 13). This needling method can activate blood flow and unblock stasis, promote qi flow and unblock collaterals, expel pathogenic wind and cold. Quyuan (SI 13) and Jianwaishu (SI 14) are both from the Hand Taiyang Meridian, working to relax tendon and unblock collaterals and kill pain. When the pointtowards-point needling method was applied to Jianwaishu (SI 14) and Quyuan (SI 13), the needle was inserted into Jianwaishu (SI 14) with its tip reaching the bone beneath Quyuan (SI 13) and at the superior-interior angle of the scapular. The needling sensation can radiate to Tianzong (SI 11), even to the elbow or little finger. Tianzong (SI 11) is also from the Hand Taiyang Meridian, working to expel pathogenic wind and relax tendons, clear heat and relieve swelling. When Tianzong (SI 11) was needled, the needle tip should be toward Naoshu (SI 10) by depth of 2.5 cun. The needle tip should reach the belly of infraspinous muscle. The needling sensation wasstrong enough to spread through the scapular to the little finger. Therefore, it’s very effective for arm pain and numbness. Shousanli (LI 10) is a point from the Hand Yangming Meridian, acting to expel pathogenic wind and unblock collaterals. When it’s needled together with Xialian (LI 8), strong needling sensation can be produced to radiate to the lateral forearm, which can unblock collaterals and promote blood flow and kill pain. EA somehow strengthens the action. The combination of point-towards-point needling method and EA can fully display the effects of the two methods, and thus can swiftly relieve the spasm and adhesion of the muscles, and reduce or release the compression from the nerves. Clinical practice shows that this integrative method, by selecting fewer points, is efficient and effective and also easy to operate[10].

In this study, EA with Jiaji (EX-B 2) andJing Fu Kangwere adopted for control study. The results told that the point-towards-point EA had better recovery rate and total effective rate, and was also more efficient in improving the symptom and function compared to the controls. It proves that point-towards-point EA is more efficient and effective in improving the symptoms and signs of CSR patients. With its convenient operation, this method is worth popularizing.

Conflict of Interest

The authors declare that there is no conflict of interest in this article.

Acknowledgments

Thank for the support of Clinical Scientific Research Project of Health Bureau of Wuhan (No. WZ11C05).

Statement of Informed Consent

All the parents signed the informed consent.

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Translator:Hong Jue

Huang Wei, M.D., lecturer.

E-mail: 24231637@qq.com

R246.1

: A

Date:September 10, 2013