Pathogenesis and TCM Treatment of Cervical Spondylosis

1. Pathogenesis and TCM Treatment ofCervical Spondylosis East West Healing Center By Dr. Leon Chen www.eastwesthealingcenter.net

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

3. ⅠLocal anatomy • Cervical aspect: the cervical vertebrae has seven vertebrae, they are a atlas(C1), a axis(C2), 3-7 cervical vertebrae(C3-C7). ①Between atlas and axis do not have disc. ②The 7th spinous process is longest. ③In cervical vertebrae has transverse foramen that differs other vertebrae.

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

5. C1, C2

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

8. 2. ligaments: ① Supraspinal ligament. ② Interspinal ligament. ③ Flava ligament. ④ Posterior longitudinal lihament. ⑤ Anterior longitudinal ligament. ⑥ Transverse ligament of atlas.

10. 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 leting 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.

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

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

14. 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

16. 3 C C 3 4 5 4 6 5 7 T1 8 2 3 4 5 6 7 T1 8 C5 9 C8 10 11 C7 12 L1 C6 4 S2 L4 L2 5 C6 S2 3 C8 C7 L3 L4 S2 L5 S1 L5 L4 S1 L4 L5 L5

17. 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 supply triceps, extensors of the wrist and hands (lift the hand), and extension thumb (adduct the thumb ). • The cutaneous nerve supply to most of the back of the hand.

22. 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 composing with C8-T1 of spinal nerves which is medial cord of the brachial plexus. • There it supplies one and a half muscles of 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 damage the ulnar nerve may the 4th and 5th finger can’t extend straight or the 5th finger can’t extension.

25. The median nerve • The median nerve is formed from parts of the medial and lateral cords of the brachial plexus, which C5-C8, T1 of 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 damage the nerve may causing can’t adduct palm.

29. 6. Vertebral artery • The vertebral artery, which is the first branch of the subclavian artery, provides another major blood supply to the brain. • The vertebral artery from the subclavian reaches the cranial cavity by passing through the transverse foramen of 1-6 cervical vertebrae.

32. 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

35. Sternocleidomastoid Trapezius

36. 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.

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

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

42. 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)

43. 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)

44. Radiation of cervical nerves

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

49. Tension arm test

50. Percuss head test