Pathogenesis and TCM Treatment of Cervical Herniated Disc

Posted by e-Medical PPT Thursday, November 1, 2012
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

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.

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

Cervical Spondylosis - Clinical Presentation
- the pain pattern is difficult to use as a way of sorting out what is going on in their spine; go with neurology! - weakness, clumsiness, L�Hermitte�s - the weakness is often greater distal than proximal
- look for ataxic, broad based gait - motor weakness is seen in 61-68% - reflexes are decreased in 70% - it is sometimes difficult to sort out the exact level of neural compression
- Spurling�s Sign: rotate and extend towards the side of complaints - exacerbates the symptoms - Axial Compression: further diminishes foraminal volume (can be done with Spurling maneuver) - Valsalva Maneuver: may increase symptoms - L�Hermitte�s phenomenon - electric shock down trunk and upper extremities with neck flexion
- overlapping findings are common, with many presenting without dermatomal pain pattern.
- look for upper motor neuron signs - hyperreflexia, spasticity, pathologic reflexes - ankle clonus, Babinski�s - Hoffman�s Reflex - flick the nail of the third finger and look for flexion of index and thumb - Inverted Radial Reflex - testing brachioradialis reflex elicits flexion of fingers - seen with compression of both C5 cord and roots.
Level Root Motor Sensory Loss
C2-3 C3 C3-4 C4 Scapula Lateral neck, shoulder C4-5 C5 Deltoid, Biceps Lateral arm C5-6 C6 Wrist ext, biceps, supination Radial forearm & hand C6-7 C7 Triceps, pronation Middle finger C7-8 C8 Finger flexion, interossei Ulnar forearm and hand C8-T1 T1 Interossei Ulnar arm

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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