Pathogenesis and TCM

Treatment of Cervical
Herniated Disc
East West Healing Center
By Dr. Leon Chen
www.eastwesthealingcenter.net
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.
Local anatomy
1. Cervical aspect: There are seven
cervical vertebrae-- the atlas(C1), the
axis(C2), and cervical vertebrae numbers
three through seven. (C3-C7).
There is no disc between the atlas and
the axis.
The 7
th
spinous process is the longest.
Cervical vertebrae have transverse
foramina that differ from other vertebrae.
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
C1, C2
Transverse foramen
Vertebral foramen
Transverse process
Centrum
Bifurcated spinous process
Lamina
Pedicle
Superior articular
facet
C3- C7
2. Ligaments:
Supraspinous ligament.
Interspinous ligament.
Ligamentum Flavum
Posterior longitudinal ligament.
Anterior longitudinal ligament.
Transverse ligament of the atlas
(intertransverse ligament.)

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.






protrusion or bulging


sequestration

Normal disc

extrusion
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.
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.
The radial nerve: C5-C8,T1 of spinal
nerves.
The Ulnar nerve: C8 and T1 of spinal
nerves.
The median nerve: C5-C8,T1 of spinal
nerves
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
The radial nerve
1) The radial nerve is a nerve in the human body
that supplies the arm, the forearm and the
hand.
2) It originates from the posterior cord of the
brachial plexus with roots from C5, 6, 7, 8, and
T1.
3) It supplies the triceps, extensors of the wrist
and hands (lift the hand), and extension thumb
(adduct the thumb ).
4) It provides the cutaneous nerve supply to most
of the back of the hand.
The ulnar nerve
1) The ulnar nerve is a nerve which runs from the
shoulder to the hand, at one part running near the ulna
bone.
2) It is composed of C8-T1 of the spinal nerves which are
the medial cord of the brachial plexus.
3) There it supplies one and a half muscles of the upper
limb (flexor carpi ulnaris and medial half of flexor digiti
profundus).
4) The ulnar nerve also provides sensory innervation to
the part of the hand corresponding to the fourth and
fifth digits.
5) If the ulnar nerve is damaged, the 4
th
and 5
th
finger
cannot fully extend, or the 5
th
finger cannot fully extend
(to a fully straightened position).


The median nerve
1) 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.
2) The median nerve is the only nerve that
passes through the carpal tunnel, where it may
be compressed to cause carpal tunnel
syndrome.
3) If damaged the nerve may cause an inability to
flex the palm.
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.
7. Main muscles of neck
1) Scalene muscles: Middle scalene;
Anterior scalene; Posterior scalene.
2) Sternocleidomastoid:
Sternal head; Clavicular head.
3) Semispinalis capitis
4) Splenius capitis
5) Levator scapula
6) Trapezius


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

1) Radicular pattern
2) Vertebral artery pattern
3) Myelopathy pattern
4) Sympathetic pattern
5) Combination pattern
Points of Diagnosis
1) Age: the most cases are over 40 years old, and men
more than woman.
2) Pain in the neck, headache (back of head), shoulder,
or radiating pain in the arm or fingers.
3) Numbness or tingling in the arm or fingers or thumb.
4) Dizziness.
5) Loss of balance.
6) Dry eyes, visual disturbances (eg, blurred vision,
diplopia)
7) Tinnitus.
8) Disturbed concentration and memory
9) Hot flash (rarely).
10) X-ray, MRI, CT: will find particular problem.

Complications

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

Radiation of cervical nerves
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.



Tension arm test
Percuss head test
Jackson test
Compression shoulder test
Traction test
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.

Differential Diagnosis
1) Brain tumor.
2) Migraine.
3) Thoracic outlet syndrome (TOS).
4) Cervical strain.
5) Frozen shoulder.
6) Tennis elbow.
Sternocleidomastoid
Treatment by TCM
1) TuiNa: RouGun (rolling and kneading), NaRou
(Grasping and kneading), An (pressing), Ban
(adjustment).
2) Acupuncture: GB20 ()GB21 ()DU14 (
)SI11 ()LI12 ()SJ 14 ()LI 4 (
)DU20 ()DU ().
3) Chinese herbs:
Wind Bi: FangFengTongShenWan,DuHuoJiShengWan.
Blood stagnation: FuFangDanShengWan.
ShenYang deficiency: ShenQiWan,
BuYangHuanWuWan, TanWangBuXinWan.
4) Traction.
I Prognosis

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



Thank you

Phone630-916-0781
E-mail: drchen12@yahoo.com
Webwww.eastwesthealingcenter.net