Non-Surgical Therapy For Prolapse of Lumbar Intervertebral Disc |
Appearing originally in The Journal of Traditional Chinese Medicine
by Wang Heshan
Department of Medical Service,#C Training Bureau of the State Sports Committee,
Beijing 100061
There were 79 male and 37 female cases in this series of patients (116 cases). Their ages ranged from 20 to 70 years, with histories of the disease for 3 days to 26 years. Of the prolapsed discs,
5 were at L#-[1-2],
12 at L#-[3-4],
42 at L#-[4-5],
23 at L#-[5]-S#-[1]
34 at L#-[4]-L#-[5]-S#-[1].
12 prolapsed discs were of central type, 43 of levo-posterior type and 61 of dextro-posterior type. Prolapse or ectasia was shown in all the affected discs on CT and MRI scanning. 47 cases had history of apparent trauma or sprain.
Therapeutic results: After treatment, the results were: cured in 52 cases, markedly effective in 41 cases, effective in 17 cases, and ineffective in 6 cases.
Discussion The above non-surgical therapy can replace the prolapsed intervertebral disc to its original position, and eliminate the adhesive inflammation of the soft tissue surrounding the nerve root. Traction can relax the tonic lumbar muscles and intensify the posterior longitudinal ligament and transverse ligament of fibrous ring to correct the lateral bending and posterior protruding abnormalities of the vertebral column, enlarge the intervertebral space, enlarge the dural capsule and intervertebral foramen, thus a negative pressure is produced in the intervertebral space, that facilitates the replacement of intervertebral disc, and in the meantime, lay a foundation for further manipulation.
Medication according to differentiation of symptoms and signs can invigorate blood circulation, remove blood stasis, activate qi flow, relieve pain, dispel wind, disperse cold, resolve dampness, strengthen tendons and bones, decrease local adhesion and edema. If the therapeutic effects are satisfactory, at the local tender point, Radices Codonopsis Compositae or procaine solution can be injected, and epidural block therapy at sacral region can be applied. Procaine and steroids can inhibit the excitement of nerve endings, improve blood circulation, thus yielding marked actions of anti-inflammation, and alleviation of pain. The symptoms can be ameliorated quite soon. If some cases with short disease course, severe symptoms are intolerable to the general maneuver, the manipulation can be performed under extradural anestheisa, or lumbar anesthesia. The lumbar muscular spasm should be fully relaxed, and the intervertebral space enlarged, so as to facilitate replacement of the prolapsed intervertebral disc, loose the nerve root adhesion, change the relation between the nerve root and prolapsed disc, restore the normal dynamic balance of vertebral column, and relieve or eliminate the clinical symptoms. However, violently forceful maneuvers should be avoided, which may induce iatrogenic injury.
Massage is contraindicated for senile patients with cardiovascular diseases, cases with central prolapse, significant bony proliferation or calcification of the prolapse, and cases who have a prolonged disease course and have been treated many times without satisfactory therapeutic results and with frequent recurrences.
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