Acupuncture is effective for patients with lumbar disc protrusions. CT scans confirm that acupuncture reduces disc protrusion size and increases healthy space in the spinal canal. Along with relief from nerve compression, investigators conclude that acupuncture improves range of motion and reduces pain for patients with lumbar disc protrusions.

Researchers from the Nanyang Municipal Central Hospital tested two acupoint prescriptions. The results of the investigation demonstrate that both acupuncture point prescriptions that were tested are effective for alleviating lumbar disc protrusions, but one is more effective than the other. We will take a look at both. CT (computed tomography) scans confirm the results, including improvements across multiple parameters (i.e., anteroposterior diameter of the thecal sac, sagittal diameter of the spinal canal, nerve root compression ratio). [1]

Patients were evaluated before and after the treatment course. Both subjective and objective instruments were used to measure patient outcomes. The objective data was gathered using CT scans (also known as CAT scans), which are computer-processed X-ray images. The scans demonstrate that acupuncture reduces disc protrusions and alleviates nerve compression. CT images confirmed improvements in the thecal sac anteroposterior diameter and sagittal diameter of the spinal canal as well as the nerve root compression ratio.

Subjective data was gathered with two instruments. First, the Oswestry Disability Index (ODI) was used to measure functional disability of the lower back. Second, the Japanese Orthopedic Association Lower Back Pain Evaluation Questionnaire (JOABPEQ) was used as an outcome measure for patients with lumbar disc protrusions. Patients demonstrated improvements with both the ODI and JOABPEQ.

 

Symptoms
The following are results of the ODI and JOABPEQ for two separate groups receiving two different acupuncture treatment point prescriptions. The ODI score for the standard acupuncture control group averaged 23.35 before treatment and 8.34 after treatment. The ODI score for the acupuncture Yao San Zhen (lumbar three needles) treatment group averaged 23.12 before treatment and 5.28 after treatment.

The JOABPEQ score for the standard acupuncture control group was 6.22 before treatment and averaged 17.14 after treatment. The JOABPEQ score for the acupuncture Yao San Zhen (lumbar three needles) treatment group averaged 6.35 before treatment and 21.53 after treatment. The researchers conclude that the Yao San Zhen treatment group outperformed the standard acupuncture control group regarding the improvements of ODI and JOABPEQ scores.

 

CT Scans
The thecal sac (dural sac) is a sheath around the spinal cord (above L2) and cauda equina. It is composed of dura mater, which is a thick connective tissue membrane. The anteroposterior diameter of the thecal sac for the standard acupuncture control group decreased to an average of 35.72 mm after treatment, from a pre-treatment value of 56.44 mm. The anteroposterior diameter for the Yao San Zhen acupuncture treatment group averaged 56.35 mm before treatment and 26.14 mm after treatment. These measurements indicate a decrease in the size of the disc protrusions.

The sagittal diameter of the spinal canal for the standard acupuncture control group averaged 6.32 mm before treatment and 11.16 mm after treatment. The sagittal diameter for the Yao San Zhen acupuncture treatment group was 6.51 mm before treatment and 14.24 mm after treatment. This parameter is negatively associated with lumbar pain and the improvements are reflected by higher numbers. The Yao San Zhen style of acupuncture outperformed the standard acupuncture protocol.

The nerve root compression ratio for the standard acupuncture control group averaged 0.64 before treatment and 0.48 after treatment. The nerve root compression ratio for the treatment group averaged 0.67 before treatment and 0.32 after treatment. Both groups achieved significant improvements in CT measured parameters. Overall, the improvements were greater for the Yao San Zhen acupuncture treatment group.

 

Correlation Between ODI and CT
Correlation between ODI and CT parameters (anteroposterior thecal sac diameter, sagittal spinal canal diameter, nerve root compression ratio) for two groups were analyzed. The results showed that the anteroposterior diameter and nerve root compression ratio were positively correlated with ODI scores, while the sagittal diameter of was negatively correlated with ODI scores. The researchers concluded that, “In patients with lumbar disc protrusion, the more severe the nerve root compression, the narrower the sagittal diameter on the CT, and the larger the anteroposterior diameter of the thecal sac, the more serious the clinical symptoms.”

 

Design
A total of 78 patients participated in the study. They were diagnosed and treated for lumbar disc protrusions between January 2016 and January 2017. The following inclusion criteria were applied:

• Meeting the diagnostic criteria for both western medicine and Traditional Chinese Medicine
• Ages between 20–50 years
• Pain in the lower back and lower extremities
• Confirmed lumbar protrusions by CT or MRI
• Positive straight leg raise (SLR) test

The following exclusion criteria were applied:

• Comorbid tumors, lumbar vertebral spondylolisthesis, spinal stenosis, and spinal compression fractures
• Severe and comorbid blood diseases and coagulation disorders
• Pregnant or lactating
• Neurological or mental diseases

Participants were randomly divided into two groups: Yao San Zhen treatment and standard acupuncture control, with 39 participants in each group. Both groups were equivalent in all relevant demographics. The treatment group was comprised of 26 males and 13 females. The average age of the Yao San Zhen treatment group was 39.21 years. The course of treatment of the Yao San Zhen treatment group was 3.53 months. The control group was comprised of 24 males and 15 females. The average age of the treatment group was 38.37 years. The course of treatment of the treatment group was 3.32 months.

 

Acupuncture Sessions
Patients from both groups received the following acupuncture points:

• Huatuojiaji
• GB30 (Huantiao) affected side
• BL54 (Zhibian) affected side
• Ashi points

Secondary acupuncture points were added bilaterally based on diagnostic considerations:

• Lower back pain due to cold-dampness: BL39 (Weiyang), GV3 (Yaoyangguan)
• Lower back pain due to damp-heat: GB34 (Yanglingquan), SP6 (Sanyinjiao)
• Lower back pain due to blood stasis: SP10 (Xuehai), BL17 (Geshu)
• Lower back pain due to kidney deficiency: KD3 (Taixi), GV4 (Mingmen)

Acupuncture treatments commenced with patients in a prone position. After disinfection of the acupoint sites, a 40 or 75 mm disposable filiform needle was inserted into each acupoint with a high needle entry speed, reaching a depth of 1–1.5 cun (with the exception of 2–3 cun for Huantiao). After achieving a deqi sensation, the needles were manipulated with the Ping Bu Ping Xie (attenuating and tonifying) technique.

The acupuncture needles were connected to an electroacupuncture device. A low frequency continuous wave (5–10 Hz) was applied with an intensity level set to patient tolerance levels or until muscle contractions were observable. The needles were retained for 30 minutes after the initiation of electric current.

For the treatment group patients, a special acupoint prescription called Yao San Zhen (lumbar three needles) of Jin’s three needling technique was added. This technique was established by Dr. Jin Rui, Ph.D. (chief professor supervisor of Guangzhou University of Traditional Chinese Medicine). The principle of the technique is to use three needle combinations to treat specific diseases. The Yao San Zhen prescription utilized the following acupoints:

• BL23 (Shenshu)
• BL25 (Dachangshu)
• BL40 (Weizhong)

Needles were inserted into each acupoint with a high needle entry speed, reaching a maximum depth of 1–1.5 cun. Upon the arrival of a deqi sensation, the needles were manipulated with the Ping Bu Ping Xie (attenuating and tonifying) technique. A 30 minute needle retention time was observed. For both groups, treatments were applied every two days, 10 sessions as one treatment course, for a total of 8 weeks.

 

Summary
The clinical results demonstrate that acupuncture produces positive patient outcomes for the treatment of lumbar disc protrusions. Patients that received acupuncture saw improvements in ODI and JOABPEQ scores and parameters measured by CT (i.e., anteroposterior diameter of the thecal sac, sagittal diameter of the spinal canal, nerve root compression ratio). The data indicates that acupuncture is safe and effective for the treatment of lumbar disc protrusions.

 

Reference
[1] Fang F, Wei YX. Clinical observation on lumbar three needles in the treatment of lumbar disc protrusion and imaging changes [J]. World Chinese Medicine, 2018(5).

Source: HealthCMi