| Part One ReviewCervical spondylosis is a clinical syndrome of spinal cord, nerves or blood vessel induced by degeneration of cervical intervertebral disc and its secondary affection. Cervical spondylosis is a common disease of spinal or nerve dysfunction in patients older than 50 years. Now cervical spondylosis sick rate of Chinese is about 7.3%-13.7% and it keeps rising.The degeneration of cervical disc is the most important and basic reason of cervical spondylosis. The secondary affections of cervical disc degeneration include protrusion of cervical disc, instability of cervical joint, and hyperosteogeny of vetrtebra body and joint. The degeneration of these tissues can compress or hurt spinal cord, nerves or blood vessels and then produce clinical symptoms.There are a lot sorts of reasons of cervical spondylosis such as cervical spine degeneration (including cervical disc and bone degeneration), cervical strain, trauma to cervical spine, bad body posture, inflammation in neck, deformity of cervical vertebra, cervical spinal canal stenosis and neck muscle diseases and so on. Degeneration changes in the spinal column result in facet arthrosis, decreased intervertebral disc height, narrowing of the neuroforamina and osteophyte formation. These changes of disc and other tissues do harm to spinal cord, nerves or blood vessels by the mechanism of dynamic or statical compression, dynamic disequilibrium of cervical vertebrae, blood circulation disturbance and immune hurt. The degeneration of cervical vertebrae includes degeneration of cervical intervertebral discs, degeneration and hyperplasia of ligaments and degeneration and hyperosteogeny of cervical joints. As degeneration changes occur, there is oncroachment on the space available for the cord, which could lead to myelopathy from extrinsic compression of alteration in cord blood supply As a clinical conception, the term "Cervical Spondylosis" has three meanings: (1) degeneration of cervical disc or cervical joint; (2) hurting of other tissues such as spinal cord, nerve and blood vessel, and (3) producing a series of secondary clinical symptoms. To constitute a diagnosis of cervical spondylosis must meet three conditions at the same time: (1) positive clinical symptoms of cervical spondylosis, (2) positive radiological signs showing the degeneration of cervical intervertebral disc or of cervical joint, and (3) the radiological signs can explain all clinical symptoms. From degeneration of cervical spine to the clinical complains may last a long time of progress. This progress has endured three phages: (1) Dysfunction phase. At this phase patients may feel exhausted easily. Some patients' cervical spine may have too big or too little a movement range. There are no positive radiological signs. (2) Degeneration and dysfunction phase. The patients may feel pain in neck, dizziness or cervical muscle spasm. The radiological check of cervical spine' s flexion or extension position may show the cervical vertebrae body move further than normal levelly or in angle. (3) Hyperosteogeny and stable phase. At this phase patients may complain stiff in neck, or other symptoms coming from spinal cord injury, nerve or blood vessels compression. According to its clinical symptoms and pathogenesy cervical spondylosis can be divided into several types. Cervical spondylotic radiculopathy (CSR), cervical spondylotic myelopathy (CSM), vertebral artery type of cervical spondylosis, and neck type of cervical spondylosis, are the commonly accepted types of cervical spondylosis.The treatment for cervical spondylosis includes surgical treatment or nonsurgical treatment. The common opinion about cervical spondylosis treatment agrees that most part of cervical spondylosis can be treated well by nonsurgical treatment. The nonsurgical treatment for cervical spondylosis includes physical therapy and rehabilitation: rest, modalities, islmetrics, aerobic conditioning, flexibility exercises, progressive resistive exercises, disease education and home program. Other treatment includes injection therapy, medication (has four classes of medication: narcotics, anti-inflammatories, antidepressants and muscle relaxants), manipulation. A successful program for nonsurgical treatment of cervical spondylosis must achieve all three goals: pain relief, improved function, and prevention of recurrence. Although many modes of treatment are available, only a comprehensive rehabilitation program of reconditioning meets all three goals. Its effectiveness in helping to prevent recurrence has been established. Functional improvement may also be maintained through such a program, and functional disability may be minimizedCervical spondylotic myelopathy is the worst type of cervical spondylosis. All pathogenesis feature of cervical spondylotic myelopathy is the compression of spinal cord. The natural history cervical spondylotic myelopathy is typically one of insidious onset, long periods of static disability, and episodic worsening. This leads to stepwise degeneration over time. The symptoms of cervical spondylotic myelopathy include motor weakness, radiculopathy, spasticity, neck pain, hand dysfunction, gait abnormalities, proprioceptive loss, and bowel and bladder dysfunction. Cervical spondylotic myelopathy keeps improving and the symptoms of patients may deteriorate gradually. Cervical spondylotic is a graded process with variable clinical manifestations. Anatomic location of compression, ischemia, and dynamic factors also contribute to its spectrum. Perhaps the most important issue in myelopathy is that it is treatable, and its early diagnosis enhances the pool of good results. Emphasis should be placed on obtaining histories of numbness and clumsiness in the hands, decreased fine motor movement, and subtle gait disorders. Suspicion of its clinical existence remains the single greatest element in the identification of early cervical spondylotic myelopathy.Early cervical spondylotic myelopathy could be treated by nonsurgical treatment. Most cervical spondylotic myelopathy patients ask for surgical treatment. Surgical treatment involves a wide decompression of the spinal cord by a posterior or anterior approach. The anterior approach may be the ideal choice for decompression in patients with up to three-level stenosis and in those with primarily anterior pathology (osteophytes, spondylosis, disc herniation, and so forth). And anterior approach is the only recommended approach for patients with cervical kyphosis who need decompressive surgery. The anterior approach for surgical treatment of CSM includes ACDF (anterior cervical discectomy and fusion) or anterior corpectomy and strut grafting. Advanced age, long duration of symptoms, and increased severity of stenosis may be associated with poorer clinical outcome. Advanced age or severe presenting functional disability should not be contraindications to surgical treatment. The posterior approach may be considered in patients with stenosis at three or more levels, segmental OPLL, previous failed surgery, and posterior impingement due to buckling or infolding of the ligamentum flavum of facet arhtropathy. The posterior approach for surgical treatment of cervical spondylotic myelopathy includes laminectomy or laminoplasty. Kyphosis associated with developmentally narrow canal or posterior compression may require combined anterior posterior approaches. Disagreement on which approach is the best choice for long-level cervical spondylotic myelopathy remains. Cervical spine fixation is continually evolving, and better and more stable constructs are becoming available. Proper instrumentation may enhance patients' rehabilitation. In stabilizing the cervical spine, the proper fusion remains the most important procedure, and spinal fixation devices can be used to augment the stability of the construct and enhance fusion rated.Cervical spondylosis belongs to bi-syndrome or flaccidity-syndrome in Traditional Chinese Medicine field. The major pathogenesis of Cervical spondylosis is deficiency of Qi, wind-cold-wetness evil and meridian obstacle by blood stasis or phlegm. The principal of therapy for Cervical spondylosis aims at both the restoration of healthy energy and elimination of evils. The available Traditional Chinese Medicine treatment method for Cervical spondylosis involves Chinese traditional herbs, acupuncture, massage, neck traction and so on. CSM belongs to flaccidity-syndrome in Traditional Chinese Medicine field and can be treated with Traditional Chinese Medicine. The main feature of Cervical spondylotic myelopathy pathogenesis is deficiency in origin and excess in superficiality. The deficiency syndrome complicates with excess symptoms. Deficiency of the kidney is the basic pathogenesis characteristic. Invigorating qi and yang, promoting blood circulation and dredging channel is now considered the good principal for working out a therapy for CSM. Now surgical or conservative combination treatment of Chinese traditional and Western medicine on cervical spondylotic myelopathy is used by a lot of doctors and has got good results.Part Two Clinical StudyObjective: To study the effects of Shenfu injection, tetramethylpyazine injection, Alprostadil injection on cervical spondylotic myelopathy (CSM) and to find some effective method or medicine for treatment of CSM.Methods: In this clinical comparative study 118 patients with CSM were treated after being divided onto two big groups: 41 patients with more sever illness in group A and 77 with slighter illness in group B. Surgical operation were the basic treatment for those in group A and cervical traction as basic treatment for those in group B. Surgical operation or cervical traction, Shenfu injection, tetramethylpyazine injection, Alprostadil injection, and Chinese herbs Buyang Huanwu Tang were used to treat the patients. 29 patients from group A were treated with surgical and combination of Chinese traditional and Western medicine (Group 1) and the other 12 patients were treated with simple surgical operation (Group 2). All patients in Group 1 were treated with surgical operation and Shenfu injection, tetramethylpyazine injection, alprostadil injection and Chinese herbs Buyang Huanwu Tang. The patients in Groups 2 were treated with simple surgical operation. There were three groups in group B, 33 patients in Group 3, 25 in Group 4 and 19 in Group 5. All patients in Group3 were treated with cervical traction, Shenfu injection, tetramethylpyazine injection, alprostadil injection and Chinese herbs Buyang Huanwu Tang. The patients in Group 4 were treated cervical traction, Shenfu injection, tetramethylpyazine injection and Chinese herbs Buyang Huanwu Tang. The patients in Group 5 were treated with cervical traction, alprostadil injection and vitamin B complex. According to evaluation of severity of myelopathy using Japanese Orthopedics Association (JOA) scores we assessed all patients before the treatment and after 2weeks, 6 months.Results: The patients in Group 1 had equal JOA recovering ratio after 2 weeks as those in Group 2. After 6 months patients in Group 1 had better JOA recovering ratio than those in Group 2 (P<0.05). The patients in Group 3 had better JOA recovering ratio and total good ratio than those in Group 4 and Group 5. The results of Group 4 and Group 5 were equal. Patients in Group 1 had an average recovering ratio 81.4% and a total good ratio 96.5% after treatment for 2 weeks. Patients in Group 2 had an average recovering ratio 75.0% and a total good ratio91.7% after 2 weeks. All patients in Group 1 had an average recovering ratio 87.1% and a total good ratio 96.5% after 6 months. All patients in Group 2 had an average recovering ratio 78.1% and a total good ratio 91.7% after 6 months. Patients in Group 3 had an average recovering ratio 77.1% and a total good ratio 93.9% after treatment for 2 weeks. Patients in Group 4 had an average recovering ratio 70.6% and a total good ratio 76.0% after 2 weeks. All patients in Group 5 had an average recovering ratio 68.9% and a total good ratio 73.7% after 2 weeks. Patients in Group 3 had an average recovering ratio 74.4% and a tetal good ratio 87.9% after treatment for 6 months Patients in Group 4 had an average recovering ratio 52.9% and a total good ratio 64.0% after 6months. All patients in Group 5 had an average recovering ratio 58.6% and an total good ratio 57.9% after 6 months. Results of statistical analysis showed that significant difference existed between Group 1 and Group 2 at 6-month follow-up (P<0.05). The average JOA recovering ratio and total good ratio of Group 3 were better than those in Group4 and Group 5 after both 2-week and 6-month follow-up check, control group (P<0.05).Conclusion: Treatments for CSM by the method of surgical operation combined with Shenfu injection, tetramethylpyazine injection, alprostadil injection and Chinese herbs Buyang Huanwu Tang could treat patients better than treatments of single surgical. Treatments of non-surgical operation combined with Shenfu injection, tetramethylpyazine injection, alprostadil injection and Chinese herbs Buyang Huanwu Tang could treat patients better than treatments of single non-surgical operation combined just Shenfu injection, tetramethylpyazine injection and Chinese herbs Buyang Huanwu Tang or just with alprostadil injection. The results of non-surgical treatments with Shenfu injection, tetramethylpyazine injection and Chinese herbs Buyang Huanwu Tang and the results of those with non-surgical treatment combined with alprostadil injection showed no distinct side effect nor harm to patients' body and so it was considered a safe treatment method for cervical spondylotic myelopathy. The reasons of the good results might relate to that the combination therapy improve or reconstruct blood circulation for spinal cord and then nourish spinal cord better. |
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