Key
Words SEP Cervical
spondylopathy EA
Cervical
spondylopathy (CS) is a common disease occurred in the middle-aged
and the aged people. Recent data indicate that this disease is
also often seen in younger people, presenting a youngish tendency.
In the past, objective standards for diagnosis and evaluation of
the therapeutic effect of CS are few, mainly due to difficulty in
systemically judging functions of cervical spinal cord and nerve
roots. In recent years, the study on application of SEP to clinic
evaluation of therapeutic results has been being conducted. As a
physiological index reflecting t he functional state of the
injured nerve tissues, SEP is of a character of nerve segment, can
replenish some defects of clinical imaging examination. From
December of 1997 to December of 1999, we conducted observation on
the therapeutic effect of EA in treatment of 60 cases of CS and
evaluated the significance of SEP. Here is the report.
General
Data
All the
60 cases of volunteer CS patients were out-patients from the
clinical department of the First Affiliated Hospital of Guangzhou
University of Traditional Chinese Medicine (TCM) and Pharmacology.
They were diagnosed as CS according to the Diagnostic Criteria of
Syndromes of TCM formulated by Chinese State Administration of TCM
and the “Standards for Diagnosis of Cervical Spondylosis"
revised by the Second Session of Symposium of Cervical Spondylosis
in 1992［1］.
Patients suffering from prolapse of intervertebral disc or those
with CS suitable for operation or those without finishing the
whole course of treatment were excluded in this study. These 60
cases were randomly and evenly divided into E A and control
groups. In the former group, of the 30 cases, 18 were male and 12
female; the oldest was 72 years and the youngest 34 years,
averaging 48.6 years. Among them, 8 cases were cervical type, 13
nerve root type, 3 spinal cord type and 6 vertebral artery type.
On the basis of differentiation of syndromes of TCM , 12 cases
were wind-cold-damp arthralgia type, 10 cases qi-stagnation and
blood stasis type and 8 the type of insufficiency of both liver
and kidney.
In
control group, of the 30 cases, 18 were male and 12 female; the
oldest was 68 years and the youngest 28 years, averaging 46.5
years. Among them, 7 cases w ere cervical type, 15 nerve root
type, 4 spinal cord type and 4 vertebral artery type. According to
differentiation of syndromes, 9 cases were wind-cold-damp
arthralgia type, 12 cases qi-stagnation and blood stasis type and
9 the type of insufficiency of both liver and kidney.
Methods
1.
Electro-acupuncture Group
Main
acupoints: Bilateral “Jingsanzhen" (Tianzhu-BL10, Bailao ,
and Dazhu-BL11); adjunct acupoints: Dazhui (GV14), Fengchi (GB
20), Fengmen (BL12), Jianjing (GB21) and Waiguan (TE5) were added
for wind-cold-damp arthralgia type; Geshu (BL17), Jianyu (LI15),
Quchi (LI11), Jianzhongshu (SI15) and Jianwaishu (SI14) were added
for qi-stagnation and blood stasis type; Yanglao (SI 6), Shenshu
(BL 23) and Taixi (KI 3) were supplemented for insufficiency of
both live r and kidney. Operation: Took Gauge-30 filiform needles
1.5 cun long to insert rapidly into the above-mentioned
acupoints separately, then manipulated the needles with
reinforcing or reducing methods according to differentiation of
syndromes. After achieving needling sensations, these acupoints
were stimulated with continuous waves, frequency of 120-250
cycles/min, continuously for 30 min by using a G-6805
Electro-acupuncture Therapeutic Apparatus. The stimulating
strength was adjusted to the extent that the patient could
tolerate. All the adjunct acupoints were bilateral and the needles
were manipulated with hand without electrical stimulation.
2.
Control Group
In
control group, the patients were treated with traction method for
30 min with a force which the patients could endure. In both
groups, the treatment was given once daily, with 15 days being a
therapeutic course. The interval between two courses was 2 days
and a total of 3 courses of treatment were given.
3.
Standards for Evaluating the Therapeutic Effect
Cured:
After treatment, all the symptoms and signs disappeared, the
myodynamia got normal, the functional activity of the neck,
shoulder and limbs recovered and the patient could take part in
normal labor or went to work as usual.
Markedly
effective: Various symptoms and signs were relieved significantly
and the patient could take care of himself or herself basically.
Effective:
Symptoms and signs including the state of disease and pain were
relieved to a certain degree. Ineffective: After treatment,
symptoms and signs had no any obvious improvement.
4.
Recording of SEP
The
volunteer patient was asked to take supine position on a bed
quietly in a shielded room. According to Foerster's dermatomere
atlas, the stimulating electrodes were separately placed on the
bilateral dermatomere areas of C4-T1. The reference and recording
electrodes were separately placed at the Erb point, C 7 and C2
spinous processes, and cerebral sensory I area (S1) on the
opposite side. SEP was recorded by using a Neuromatic-2000 C
Recorder, with the sensitivity being 100 mV, band-pass frequency
30-1500 Hz. The signals were superimposed 200 times. The
stimulating parameters were frequency of 5 Hz, rectangular waves
of constant voltage of 110 V, and duration of 100 μs. The
stimulating strength was adjusted to the extent that a slight
muscular spasm could be seen. Each figure was collected 3 times
and recorded if the duplication could meet the requirement. The
room temperature was maintained at 20-25oC.
Results
1.
Comparison between Two Groups in the Therapeutic Effect
After 3
courses of treatment, the total effective rate of EA and control
group s were 97.7% and 73.3% respectively. Ridit test showed a
significant difference between the two groups in the total
effective rate (u =3.08, P<0.01), the therapeutic effect of EA
was apparently superior to that of traction therapy (Table 1).
Table
1. Comparison of the Therapeutic Effect
between
EA and Control Groups Cases(%)
| Groups |
Cases |
Cured
|
Markedly
effective |
Effective |
Ineffective |
Total
effective rate |
|
| EA |
30 |
19(63.3%) |
6(20.0%) |
4(13.3%) |
1(3.3%) |
96.7% |
| Control |
30 |
6(20.0%) |
5(16.7%) |
11(16.7%) |
8(26.7%) |
73.3% |
|
2.
Comparison between Two Groups in SEP Changes
After
treatment, the amplitudes of various components of SEP increased
significantly and the latencies among the peaks shortened to a
certain degree. In EA group, the increased values of various
components of SEP amplitude, except for N 9 (P>0.05), were all
larger than those of control group (P<0.05 for N11, P<0.01
for N13 and N20); the values of shortened latency of different
components of SEP, except for N13-N20, were all larger than those
of control group (P<0.01 for N9-N13 and N9-N20, Table 2).
Table
2. Comparison between EA and Control Groups in the Difference
Values
of Pre-and Post-Treatment of Various Components of SEP (M±S)
|
| Groups |
|
Amplitude (μV) |
Latency (ms) |
|
|
|
| N9 |
N11 |
N13 |
N20 |
N9-
N13
|
N13-
N20
|
N9-
N20
|
|
| EA |
0.37±
0.13* |
1.35±
0.28# |
1.61±
0.32** |
1.05±
0.17** |
3.35±
0.49** |
0.20±
0.08* |
4.7 6±
0.56** |
|
|
Control
|
0.28±
0.15
|
0.89±
0.28
|
0.67±
0.14
|
0.53±
0.11
|
1.78±
0.48
|
0.34±
0.1 4
|
2.23±
0.36
|
|
*P>0.05,
#P<0.05, **P<0.01 in comparison with control group
Discussion
In the
central nervous system, stimulation upon receptors, sensory nerve
or any part of the sensory conducting pathway can
generate detectable electrical changes. This kind of evoked
potentials is a slow electrical change, sometimes, called as field
potential which is formed by the summation of multiple
post-synaptic potentials rather than by single cell discharge.
There is a latency from the stimulation exerted on tissues to the
appearance of SEP. The latency depends on f our factors: 1) the
conduction speed of stimulation-evoked impulses along nerve; 2)
the distance between the stimulating site and recording point; 3)
the number of the synapses passed by the impulses along the
pathway; and 4) the delayed time of impulses through synapses.
Under same experimental conditions, if the distance between
stimulating site and recording point keeps constant, the number of
synapses in the conducting pathway are same. In normal people, the
conduction speed of nerve is same basically. If the conduction
speed changes considerably, it suggests a pathological change
being in the nerve pathway. The synaptic delayed time is
influenced by the state of central nerve system and the
stimulation strength, varying between 0.9-0.5ms. Therefore,
abnormal changes of SEP are because of alternation of nerve
conduction speed and synaptic delay. Stimulating the different
nerve trunks or their skin region and observing potential changes
can make an objective assessment on the functions of cervical
nerve roots and the spinal cord. It was held that SEP reflected
the pathological characters, severity o f the disease and
therapeutic results of CS in a certain degree［2］.
In the pre
sent study, results
showed that in CS patients, the amplitude of SEP lowered
significantly, the latency of inter-peaks delayed considerably,
particularly N13 in nerve root type and spinal cord type patients.
It is probably due to that N1 3 originates from the dorsal horn of
the cervical spinal cord［3］,and
thus reflects the functional state of the spinal cord. After EA
treatment, the amplitude and latency of inter-peaks
of SEP were improved apparently and there was a correlation
between SEP changes and clinical therapeutic effect. It indicates
that SEP is not only a noninvasive detection method for
cervical spondylopathy but also an objective index for evaluating
its therapeutic effect. It is thus of greater clinical value.
References
1 第二届颈椎病专题座谈会纪要.中华外科杂志,1993,31(8):472.
2 丁学潮.20-40岁颈椎病的短潜伏期体感诱发电位.中国运动医学杂志,1993,12(3):133.
3 Jones
SJ. Short latency potential recorded from the neck and scalp
following median nerve stimulation in man. Electroenceph Clin
Neurophysiol, 1977,43 (6): 85 3.
back
