A Randomized Controlled Clinical Trial On Lumbar Intervertebral Disc Protrusion Treatment By Acupuncture And Manual Manipulation

Lumbar Intervertebral Disc Protrusion (LIDP) is a common and frequently occurred disease in the clinic and often manifests as lumbago and leg pain. Among all the non-operative therapies, manual manipulation can relieve spasm in the lumbar muscles, adjust the small joint disorders in the lumbar vertebrae, change the position of the protrusion and relieve the local mechanical compression, while acupuncture functions as improving the peripheral microcirculation of the nerves, promoting the release of endogenous opioid peptide, relieving pains and improving the nervous functions. Hence, the combination of manual manipulation and acupuncture is one of the choices for LIDP treatment.Objective:To compare the effects on LIDP treatment by acupuncture combining with manual manipulation versus pure manual manipulation, observe the effect difference by the two treatments among different syndromes (including types of Blood Stasis, Cold Dampness, Damp Heat and Kidney Deficiency), thus find out the proper treatment protocols for different syndromes to guide the clinical practice.Methods:The subjects were LIDP patients collected from June,2007 to June,2009 in the Massage Department of Guang'anmen Hospital, China Academy of Chinese Medical Sciences. Totally 120 cases were included and randomized into two groups with 60 cases in each group. The treatment group was applied with acupuncture with manual manipulation while the control group was with manual manipulation only, both once every other day, ten times as a course. The following items were recorded, measured and compared for the clinical effect evaluation and group comparison:JOA scores (standards for evaluating lumbago therapeutic effect by Japanese Orthopedic Association), VAS scores (Visual Analogue Scale), lumbar mobility (measured by self-made three-dimensional lumbar actometer), scores of sensory disturbance in the lower limbs and pressing response intensity in the Jiaji points (EX-B2) (measured by self-made manometer with same pressure before and after the treatment). The data was analyzed by SPSS13.0 Software. Qualitative data was tested by Chi-square test, measurement data by t-test, ranked counting data by Two-independent-samples nonparametric test, and correlation analysis for ordinal categorical variables by Kendall's rank correlation coefficient analysis.Results:1. There is no significant difference between the two groups in the gender, age, body height, weight, disease course, duration after the attack, location of the affected intervertebral disc, direction of the protrusion, and rates of different syndromes. The two groups are with homogeneity and comparable.2. There is no significant difference between the two groups in JOA scores, VAS scores, lumbar mobility, scores of sensory disturbance in the lower limbs and pressing response intensity in the Jiaji points (EX-B2) before the first treatment. The two groups are comparable.3. There is no obvious difference of the effects between the two groups but significant difference of the effects on the Cold Dampness syndrome in the two groups.4. There is significant difference of the JOA scores, VAS scores, lumbar mobility, scores of sensory disturbance in the lower limbs, and pressing response intensity in the Jiaji points (EX-B2) in the groups before and after the treatment, and also between the two groups after the treatment.5. The effects are obvious correlated with the disease course and pressing response intensity in the Jiaji points (EX-B2).Conclusion:1. Acupuncture with manual manipulation is better than pure manual manipulation in improving the JOA scores, especially after the third treatment in the Cold Dampness and Damp Heat syndromes of the LI DP patients, and in the four syndromes after ten times of treatment.2. Acupuncture with manual manipulation is better than pure manual manipulation in decreasing the VAS scores, especially in the Blood Stasis, Cold Dampness and Damp Heat syndromes after the third treatment.3. Acupuncture with manual manipulation is better than pure manual manipulation in improving the lumbar mobility of anteflexion, posterior extension and lateroflexion, and better in improving the anteflexion and posterior extension in the Cold Dampness syndrome.4. Acupuncture with manual manipulation is better than pure manual manipulation in improving the scores of the sensory disturbance in the lower limbs in the Kidney Deficiency, Damp Heat and Cold Dampness syndromes.5. Acupuncture with manual manipulation is better than pure manual manipulation in relieving the pressing response intensity in the Jiaji points (EX-B2); there are no obvious changes of the response intensity in the Kidney Deficiency syndrome before and after the treatment; the effects and the Jiaji points response intensity are with negative correlation, i.e., the stronger the response intensity after the treatment, the worse the effects.6. The effects in the treatment group and control group both are good; acupuncture with manual manipulation is better than pure manual manipulation in the Cold Dampness syndrome of the.LIDP patients; the effects and the disease course are obviously correlated, i.e., the longer the disease course, the worse the effects.