Cervical Spondylosis-East West Healing Center PowerPoint Presentation

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Pathogenesis and TCM Treatment of Cervical Herniated Disc East West Healing Center By Dr. Leon Chen www.eastwesthealingcenter.net

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Definition  Cervical spondylosis is a disorder caused by abnormal wear on cervical vertebrae with degeneration and mineral deposits in the attachments of the cervical vertebrae, causing pain and weakness in the neck and arm, and changes in sensation.

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ⅠLocal anatomy Cervical aspect: There are seven cervical vertebrae-- the atlas(C1), the axis(C2), and cervical vertebrae numbers three through seven. (C3-C7). ① There is no disc between the atlas and the axis. ②The 7th spinous process is the longest. ③Cervical vertebrae have transverse foramina that differ from other vertebrae.

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Transverse foramen Vertebral foramen Odontoid process (dens) of axis Transverse ligament of atlas Atlas (C1) Axis (C2) Spinous process Anterior arch of atlas Posterior arch of C1

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C1, C2

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Transverse foramen Vertebral foramen Transverse process Centrum Bifurcated spinous process Lamina Pedicle Superior articular facet C3- C7

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2. Ligaments: ① Supraspinous ligament. ② Interspinous ligament. ③ Ligamentum Flavum ④ Posterior longitudinal ligament. ⑤ Anterior longitudinal ligament. ⑥ Transverse ligament of the atlas (intertransverse ligament.)

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3. Discs: 1) *Hyaline Cartilage: is the cartilage of the superior and inferior surfaces of the vertebral body. It also forms the top and bottom border of nucleus pulposus. It bears the weight and protects the nucleus pulposus. 2) *Annulus Fibrosus: is a fibrous ring, like a radial tire. It is elastic, embracing and holding the nucleus pulposus, not letting it herniate. 3) *Nucleus Pulposus: is a kind of gelatinous, flexible, semifluid material, located in the center of the annulus fibrosus. Both top and bottom surface are sealed by hyaline cartilage.

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髓核 纤维环 脊髓 神经根 椎间盘膨隆 protrusion or bulging 破裂椎间盘 游离椎间盘 sequestration 正常椎间盘 Normal disc 破裂型 extrusion

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4. Cervical plexus: The cervical plexus is formed by the ventral rami of the C1-C4 spinal nerves. These nerves supply the muscles and skin of the head, neck, shoulder, and chest.

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5. Brachial plexus: The brachial plexus is composed C5, C6, C7, C8 and T1 spinal nerves. Those include a radial nerve, a median nerve, a ulnar nerve. ① The radial nerve: C5-C8,T1 of spinal nerves. ② The Ulnar nerve: C8 and T1 of spinal nerves. ③ The median nerve: C5-C8,T1 of spinal nerves

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S2 S1 4 5 C 3 4 5 6 7 8 3 4 5 C S2 L1 L2 L3 L4 L5 S1 T1 T1 2 3 12 4 5 6 7 8 9 10 11 C5 C6 C8 C7 C8 C7 C6 S2 L5 L4 L5 L4 L5 L4 3

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The radial nerve The radial nerve is a nerve in the human body that supplies the arm, the forearm and the hand. It originates from the posterior cord of the brachial plexus with roots from C5, 6, 7, 8, and T1. It supplies the triceps, extensors of the wrist and hands (lift the hand), and extension thumb (adduct the thumb ). It provides the cutaneous nerve supply to most of the back of the hand.

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The ulnar nerve The ulnar nerve is a nerve which runs from the shoulder to the hand, at one part running near the ulna bone. It is composed of C8-T1 of the spinal nerves which are the medial cord of the brachial plexus. There it supplies one and a half muscles of the upper limb (flexor carpi ulnaris and medial half of flexor digiti profundus). The ulnar nerve also provides sensory innervation to the part of the hand corresponding to the fourth and fifth digits. If the ulnar nerve is damaged, the 4th and 5th finger cannot fully extend, or the 5th finger cannot fully extend (to a fully straightened position).

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The median nerve The median nerve is formed from parts of the medial and lateral cords of the brachial plexus, C5-C7, T1 of the spinal nerves, and continues down the arm to enter the forearm with the brachial artery. The median nerve is the only nerve that passes through the carpal tunnel, where it may be compressed to cause carpal tunnel syndrome. If damaged the nerve may cause an inability to flex the palm.

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6. Vertebral artery The vertebral artery, which is the first branch of the subclavian artery, provides one of the major blood supplies to the brain. The vertebral artery originates at the subclavian, and reaches the cranial cavity by passing through the transverse foramina of cervical vertebrae 6 through 1.

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7. Main muscles of neck Scalene muscles: ①Middle scalene; ② Anterior scalene; ③Posterior scalene. 2) Sternocleidomastoid: ① Sternal head; ②Clavicular head. 3) Semispinalis capitis 4) Splenius capitis 5) Levator scapula 6) Trapezius

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Trapezius Sternocleidomastoid

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Ⅱ Pathogenesis Intervertebral disc herniation: ① Injury; ② degenerative changes. 2) Degeneration of cervical vertebrae: ① Osteophytosis of the vertebral bodies. ② Hypertrophy of the facets and laminal arches. 3) ligamentous and segmental instability.

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Ⅲ Pattern of Cervical Spondylosis Radicular pattern Vertebral artery pattern Myelopathy pattern Sympathetic pattern Combination pattern

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Ⅳ Points of Diagnosis Age: the most cases are over 40 years old, and men more than woman. Pain in the neck, headache (back of head), shoulder, or radiating pain in the arm or fingers. Numbness or tingling in the arm or fingers or thumb. Dizziness. Loss of balance. Dry eyes, visual disturbances (eg, blurred vision, diplopia) Tinnitus. Disturbed concentration and memory Hot flash (rarely). X-ray, MRI, CT: will find particular problem.

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Ⅴ Complications Chronic neck pain Progressive loss of muscle function or feeling Permanent disability (occasional) Inability to retain feces (fecal incontinence) or urine (urinary incontinence)

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Ⅵ Symptoms     Neck pain (may radiate to the arms or shoulder) Loss of sensation or abnormal sensations of the shoulders, arms, or (rarely) legs Weakness of the arms or (rarely) legs Neck stiffness that progressively worsens Loss of balance Headaches, particularly in the back of the head Loss of control of the bladder or bowels (if spinal cord is compressed)

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Radiation of cervical nerves

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Ⅶ Physical Examination 1) Cervical movement: Flexion 35-45°; Extension 35-45°; Lateral bending 45°; Rotation 60-80°. 2) Tension arm test. 3) Percussion head test. 4) Spurling test. 5) Jackson test. 6) Compression shoulder test. 7) Traction test.

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Tension arm test

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Percuss head test

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Jackson test

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Compression shoulder test

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Traction test

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Ⅷ Imaging A spine or neck x-ray shows abnormalities that indicate cervical spondylosis. A CT scan or spine MRI confirms the diagnosis. A myelogram (x-ray or CT scan after injection of dye into the spinal column) may be recommended to clearly identify the extent of injury. An EMG may also be recommended. An x-ray of the lower (lumbar) spine may reveal degenerative changes in this region.

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Ⅸ Differential Diagnosis Brain tumor. Migraine. Thoracic outlet syndrome (TOS). Cervical strain. Frozen shoulder. Tennis elbow.

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Sternocleidomastoid

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Ⅹ Treatment by TCM TuiNa: RouGun (rolling and kneading), NaRou (Grasping and kneading), An (pressing), Ban (adjustment). Acupuncture: GB20 (风池)，GB21 (肩井)，DU14 (大椎)，SI11 (天宗)，LI12 (曲池)，SJ 14 (外关)，LI 4 (合谷)，DU20 (百会)，DU (上星). Chinese herbs: ① Wind Bi: FangFengTongShenWan,DuHuoJiShengWan. ② Blood stagnation: FuFangDanShengWan. ③ ShenYang deficiency: ShenQiWan, BuYangHuanWuWan, TanWangBuXinWan. 4) Traction.

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ⅩI Prognosis   Most patients with cervical spondylosis will have some chronic symptoms, but they generally respond to non-operative interventions and do not require surgery.

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Thank you Phone：630-916-0781 E-mail: drchen12@yahoo.com Web：www.eastwesthealingcenter.net