Clinical Efficacy and Safety of "Three-Dimensional Balanced Manipulation" in the Treatment of Cervical Spondylotic Radiculopathy by Finite Element Analysis.

Shengnan Cao,Guangjian Hou,Bin Shi,Congan Wang,Guodong Sun,Yuanzhen Chen,Feng Zhang,Dandan Wang,Shifei Sun,Yuzhen Xu

doi:10.1155/2021/5563296

Abstract

Cervical spondylotic radiculopathy (CSR) is the most commonly encountered cervical spine disorder. Cervical manipulation has been demonstrated as an effective therapy for patients. However, the mechanisms of manipulations have not been elucidated. A total of 120 cervical spondylotic radiculopathy patients were divided into the “three-dimensional balanced manipulation” treatment group (TBM group) and control group randomly. The control group was treated with traditional massage; the TBM treatment group was treated with “three-dimensional balanced manipulation” based on traditional massage. The symptoms and clinical efficacy of the patients were compared before and after treatment for one month. A three-dimensional finite element model was established. The mechanical parameters were imported to simulate TBM, and finite element analysis was performed. The results showed that the total effective rate was significantly higher in the TBM group compared with the control group. The biomechanical analysis showed the vertebral body stress was mainly distributed in the C3/4 spinous processes; the deformation mainly concentrated in the anterior processes of the C3 vertebral body. The intervertebral disc stress in the C3~C7 segment was mainly distributed in the anterior part of the C3/4 intervertebral disc, and the deformation extends to the posterior part of the C3/4 nucleus pulposus. In summary, these data are suggesting that TBM was effective in CSR treatment. The results of the finite element model and biomechanical analysis provide an important foundation for effectively avoiding iatrogenic injuries and improving the effect of TBM in the treatment of CSR patients.

Highlights

Cervical spondylotic radiculopathy (CSR) is the most commonly encountered cervical spine disorder among middle-aged and elderly people, accounting for 60% to 70% of cervical spondylosis cases in China [1]
In a comparison of the changes in symptoms and signs before and after treatment in the control and threedimensional balanced manipulation” (TBM) groups, the Visual Analogue Scale (VAS) scores in the two groups were obtained before treatment (P > 0:05)
Since we found that TBM could increase vertebral body and intervertebral disc displacement in a finite element models (FEM), which may be beneficial for increasing the intervertebral space, expanding the intervertebral foramen, relieving the mechanical compression of the nerve roots by the upper and lower articular processes, and relieving the nerve root compression and stimulating symptoms

Summary

Introduction

Cervical spondylotic radiculopathy (CSR) is the most commonly encountered cervical spine disorder among middle-aged and elderly people, accounting for 60% to 70% of cervical spondylosis cases in China [1]. Based on traditional rotatory manipulation and comprehensive consideration of cervical anatomy, physiology, and biomechanics, we developed a manipulation therapy named “threedimensional balanced manipulation” (TBM) and widely used this TBM in the treatment of CSR patients [4]. During the treatment of manipulation, the stress distribution in different parts of the cervical spine is critical to the safety of the manipulation. The biomechanical mechanism of manipulation therapy for the treatment of conditions involving the cervical vertebra has not yet been elucidated. This is because that there is a scarcity of specimens for in vitro investigations and the distribution of and changes in stress within the cervical vertebrae cannot be measured by traditional experimental methods [5].

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