TCM For

Cervical
Spondylosis
BY
PROF. DR SAMY A NASEF
DEAN, ECU
 Cervical spondylosis

 The primary risk factor and contributor to the incidence of

cervical spondylosis is age-related degeneration of the intervertebral
disc and cervical spinal elements.
Degenerative changes in surrounding structures, including the
uncovertebral joints, facets joints, posterior longitudinal ligament
(PLL), and ligamentum flavum all combine to cause narrowing of
the spinal canal and intervertebral foramina.
 Accelerated disease process

 Factors that can contribute to an accelerated disease process and

early-onset cervical spondylosis include exposure to significant
spinal trauma, a congenitally narrow vertebral canal, dystonic
cerebral palsy affecting cervical musculature, and specific athletic
activities like rugby, soccer, and horse riding.
Radiological
findings
 Pathophysiology

The pathogenesis of cervical spondylosis involves a degenerative cascade that

produces biomechanical changes in the cervical spine, manifesting as secondary
compression of neural and vascular structures.

 An increase in the keratin-chondroitin ratio prompts changes to the

proteoglycan matrix resulting in loss of water, protein, and mucopolysaccharides
within the intervertebral disc.
 Pathophysiology

Desiccationof the disc causes the nucleus pulposus to lose its elasticity as it shrinks and
becomes more fibrous.

As the nucleus pulposus loses its ability to maintain weight-bearing loads effectively, it
begins to herniate through the fibers of the annulus fibrosus and contributes to the loss of
disc height, ligamentous laxity, and buckling, and compression of the cervical spine.
 Pathophysiology

 With further disc desiccation, the annular fibers become more mechanically
compromised under compressive loads, producing significant alterations in the load
distribution along the cervical spine.
The result is a reversal of the normal cervical lordosis. Progression of the kyphosis
causes the annular and Sharpey’s fibers to peel off from the vertebral body edges,
resulting in reactive bone formation.
 These bone spurs or osteophytes can form along the ventral or dorsal margins of
the cervical spine, which can then project into the spinal canal and intervertebral
foramina.
 Axial Neck Pain

o Commonly complain of stiffness and pain in the cervical

spine that is most severe in the upright position and relieved
with bed rest when removing the load from the neck
o Neck motion, especially in hyperextension and side-bending,
typically increases the pain
o Occasionally, patients can present with atypical symptoms of
cervical angina such as jaw pain or chest pain
 Cervical Radiculopathy

o Radicular symptoms usually follow a myotome distribution

depending on the nerve root(s) involved and can present as
unilateral or bilateral neck pain, arm pain, scapular pain,
paresthesia, and arm or hand weakness
o Pain is exacerbated by head tilt toward the affected side or by
hyperextension and side-bending toward the affected side
 Cervical
Radiculopathy
 Cervical Myelopathy

o Typically has an insidious onset with or without neck pain (frequently absent)
o Can initially present with hand weakness and clumsiness, resulting in the
inability to complete tasks requiring fine motor coordination (e.g., buttoning a
shirt, tying shoelaces, picking up small objects)
o Frequent reports of gait instability and unexplained falls
o Urinary symptoms (i.e., incontinence) are rare and typically appear late in
disease progression
Cervical
myelopathy
Surgical
intervention
 Non-surgical treatment

The mainstay of non-surgical treatment is a four- to six-week course of physical

therapy, including isometric and resistance exercises to strengthen the neck and
upper back muscles.
 Pharmacologic agents, including nonsteroidal anti-inflammatory drugs
(NSAIDs), oral steroids, muscle relaxants, anticonvulsants, and antidepressants can
be prescribed for pain relief.
Therapy can be escalated to opioid analgesics for refractory axial neck pain but is
not recommended as first-line or for long-term use due to their potential adverse
effects.
 TCM and cervical pain

 This is achieved via interaction and integration of the two different

sensations of the acupuncture signal and the pain signal at different levels
of the central nervous system.
 In terms of the neurochemical mechanisms, a series of studies have shown
that interactions between different ‘classical’ neurotransmitters in the
prefrontal cortex mediate the inhibition of pain perception.
 5-hydroxytryptamine (serotonin) have been implicated in the modulation
of central and peripheral pain.
 Like serotonin, norepinephrine (NE) is an important transmitter of the post
ganglia sympathetic nerve and many other central neurons.
TCM in cervical
spondylosis
 Acupuncture points
for cervical pain
 Cervical
myelopathy
 In addition, compelling evidence suggests that acupuncture can increase the
release of opioid peptides in the brain, regulate the content of β-endorphin
(β-EP), and induce analgesia This indicates that acupuncture is an effective
treatment option for NP