Clinical Study on Cervical Spondylitis

Dr. Vashudev Upadhyay

Definition:
Cervical spondylosis is a degenerative condition of the cervical spine. There is degeneration of inter-vertebral disc, with its protrusion and bony overgrowth of adjacent vertebrae causing compression of roots, cord or both. Occasionally it is associated with noncompressive myelopathy consequent to vascular degeneration.

Aetiology:
Factors, which affect the development of cervical spondylosis, include Age, Sex, Occupation, Posture, etc. are discussed here: 1. Age: Disease process which includes degenerative changes are already present from 40 years of age. As age advances they become more prominent, after 50 years of age all most all subjects are likely to present some spondylotic changes in their spine . Thus age plays and important role in the pathogenesis of cervical spondylosis. 2. Occupation: Gantenberg, in a survey of a large series of cases found that in miners there was high incidence of spondylosis followed by factory workers . Excessive movement of particular area initiate degenerative changes and ultimately leads to spondylosis. 3. Trauma: Trauma specially in cervical region may plays an important role in causing of cervical spondylosis. Exertion, Regular travelling for long distances specially on bad roads, strainful movements etc. also cause trauma in cervical spine. 4. Posture: Bad posture, use of cushy pillows and a soft bed are also considered in the aetiological factors. Incorrect positioning of the head in bed, especially while lying on the tummy with the head turned to one side develops a stiff neck in some patients. Fast mechanical life full of tension, lack of exersice etc. factors are also included in the aetiological factor.

Clinical Features:
The symptoms are related to (a) the spine itself, (b) root compression, (c) cord compression, (d) combined root and cord compression, (e) vascular insufficiency. (a) Spinal symptoms Neckpain, medial scapular pain and shoulder pain probably originate in the disc and spine. (b) Root compression (Radiculopahty) The range of movement is reduced particularly during rotation and lateral movement of the head. Pain starts from the trapezius ridge (C4), tips of the shoulder (C5), anterior part of the arm (C6), radial forearm (C6), and often the thumb (C8) or all the fingers (C6, C7, C8).

INVESTIGATION:
A plain X-ray of the cervical spine is helpful. There is impairment of natural cervical lordosis, reduction of intervertebral spaces, osteophytic projection leading to distortion and encroachment of intervertebral foramina (in appropriate obligue view), and shortening of AP diameter of the cervical canal in few cases. CT scan with or without contrast is preferred if available. MRI is another useful mode of invetigation.

TREATMENT:
Conservative treatment with analgesics and nonsteroidal anti-inflammatory agents, supplemented by physiotherapy is quite sufficient in a majority of cases. The latter includes cervical traction, short-wave diathermy or ultrasonic irradiation, static and dynamic neck exercises and cervical colar to reduce neck movements. Diabetes mellitus, which is known to predispose to ontrapment neuropathy, should be carefully controlled if present. In intractable root pain, formainotomy, and in compressive myelopathy, surgical decompression or removal of spondylotic bars in selected cases, with or without spinal fusion has been successful in trained hands.

Griva Hundanam viz.-a-viz. Cervical Spondylosis:

The main symptom of cervical spondylosis, are pain in the neck, stiffness of the neck muscles, rediation of pain to the arms and restricted movements of the neck. In, Ayurvedic texts, there are many other ailments, which are related to neck and demonstrate the similar symptoms. So it is worthy to have a look on these manifestations. This will help in differential doagnosis and also in justification to the paralance with Griva Hundanam. Those diseases are:
1. 2. 3. 4. 5. 6. 7. Manya Stambha Manya Graha Griva Stambha Asthi Majja Gatavata Sandhigata Vata Visvaci Sirograha

Patients and Treatment of Cervical spondylosis:

19 patients of Cervical spondylosis (Griva Hundanam) were registered on the basis of symptomatology of cervical spondylosis from Ojus Ayurveda Hospital and Research Centre, Kathmandu. The patient were selected randomly, irrespective of their age, sex, religion etc. All the selected patients were further investigated clinically on the basis of specially prepared proforma, incorporating all the points of history taking and physical examination mentioned in Ayurveda as well as in modern texts, including the locomoter system examination. The detailed account of clinical history was taken and physical examination of each patient was undertaken on the basis of this proforma. study carried out on these patients showed that the 48.3% patients were having 6 months of chronicity followed by 24.1% were having 6 to 12 month of chronicity, 24% patients had a history of trauma and 20.7% had history of exertion in neck, Amongst the chief complaints, neck pain was found in all the 100% patients, stiffness in 96.6%, tenderness in 41.4%, tingling in hand in 38% and headache was found in 24.1% patients. In the maximum patients of this series the referred shoulder pain (65.5%), stiffness (89.7%) and tenderness of neck (28%) was found.

Abhyanga :
Abhyanga has been considered as important part of the external Snehana. In the classics Snehana means oleation. The patients of this group were carefully examined specially according to the locomoter examination given in the modern texts and the affected muscles or muscle group were elicited. Highest importance was given to those affected muscles during Abhynaga, which was done once in the morning 15 minutes. They were also given instructions regarding dos and donts. No other medication was given to the patients during the Abhyanga . Cervical spondylosis (Griva Hundanam) is a degenerative condition of cervical spine, particularly of the intervertebral disk, with its protrusion and bony over growth of adjacent vertebrae, causing compression of nerve roots or cord or both. Its symptoms of vitiated Vata like stiffness, pain etc. manifest through muscles, can be relieved by the local application of Abhyanga. Particularly if done on the affected muscles can provide better relief. It should be performed skillfully, for which proper stroks should be used. Taking in the consideration of all these things, Kshira Bala Lachhadi Taila was used for Abhyanga.

Purva Karma:
1. The medicated oil was heated up to luke warm 2. The patients were asked to sit on a stool comfortably.

Pradhana Karma:
1. First a small amount of hot oil was taken on palm and was applied on the affected part than the procedure of Abhyanga was started on the affected muscles or muscle groups. Other hand stroking pattern was used for Abhyanga, which was performed with the whole hand or fingers. It comprised the passage of relaxed hand over patients skin with a rhythm and pressure that produces a relaxing effect. Kneading and friction type of strokes were used in the procedure of Abhyanga. Kneading: In this technique, the hands were placed on the skin and moulded according to the part. Then moved with pressure according to the need. To localize the effects, the fingers or thumb were used, and where deep pressure was required, one hand reinforced the other. Frictions: These small range movements were applied with the thumb or finger starting superficially and working deeper. They were applied in one of two ways Transverse or circular. Transverse frictions as the name implies were applied at right angle to the long of the structure being treated. Circular frictions were used to produce localized effects on muscles, which have been in a prolonged state of tension e.g. the paravartebral muscles. They were also be applied to tissues where there was a nerve trunk, which may be embeded in adhesions. During the massage on the arm, patients hand was lifted by one hand and Abhyanga was performed by the other hand to cover the affected muscles of the arm. Abhyanga was performed for 15 minutes once in the morning every day for 45 days.

Pascat Karma: Excess oil from the body was removed by the cloth piece.
After Abhyanga patients were asked to cover the affected part with a cotton or woolen blanket. Patients were asked to rest for about half an hour. They were asked to take bath by warm water after rest. The patients were assessed weekly for improvement in signs and symptoms of the disease. The results of 19 patients of cervical spondylosis treated with Abhyanga (Kshir bala lacchadi taila) showed that it provides significant relief in pain (60%), stiffness (71.42%), restricted neck flexion (53.84%), restricted neck extension (60%), restricted lateral neck rotation (66.66%), diminished muscle power (78%).

On the basis of this study it can be concluded that kneading and friction may be added to the Abhyanga with Kshir bala lacchadi taila to provide maximum relief. Dr. Vashudev Upadhyay is Consultant Panchakarma Physician at Ojus Ayurveda Hospital and Research Centre.