[논문]Cervical and Lumbar Herniated Nucleus Pulposus Resorption after Acupotomy with Integrative Korean Medicine Treatment: A Case Series of Two Patients

Lee, Ye Ji; Kim, Jae Ik; Kim, Hyo Bin; Jeon, Ju Hyun; Kim, Eunseok; Kim, Young Il

doi:10.13045/jar.2019.00031

Cervical and Lumbar Herniated Nucleus Pulposus Resorption after Acupotomy with Integrative Korean Medicine Treatment: A Case Series of Two Patients 원문보기

Journal of acupuncture research, v.36 no.2, 2019년, pp.107 - 112

Lee, Ye Ji (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University) , Kim, Jae Ik (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University) , Kim, Hyo Bin (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University) , Jeon, Ju Hyun (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University) , Kim, Eunseok (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University) , Kim, Young Il (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University)

Abstract ▼ AI-Helper

The aim of this study was to report on the resorption of herniated nucleus pulposus following acupotomy treatment. Two patients were treated with acupotomy which included integrative Korean Medicine treatment, for either cervical, or lumbar herniated nucleus pulposus. Magnetic Resonance Imaging was used to produce images before and after (several months) treatment. The Numerical Rating Scale scores and Range of Motion were used to assess the patients at admission and discharge. In both cases, substantial resorption of the respective herniated disc was observed in the magnetic resonance images, with a decrease in the Numerical Rating Scale score. Range of Motion improved in 1 case. This study shows that acupotomy treatment may be a clinically effective treatment for herniated nucleus pulposus resorption and pain relief.

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문제 정의

Acupotomy is an intervention that combines acupuncture therapy of traditional Korean Medicine with the surgical therapy of Western medicine. The aim is recovery of function to a normal active state by detaching the adhesion and nodes, of the damaged soft tissue [2]. In the last decade, numerous clinical trials have been conducted looking at the effectiveness of conservative Korean Medicine treatment on cervical and lumbar HNP, where acupotomy interventions have resulted in improvements [3-5].
However, few studies in Korea have reported follow-up radiological changes (CT or MRI) after acupotomy. The objective of this case series was to report clinically meaningful changes observed by MRI after acupotomy and integrative Korean Medicine treatment of cervical and lumbar HNP. This study was exempted from Institutional Review Board (IRB) deliberation (IRB No.

제안 방법

Acupuncture was performed twice a day at acupoints on sites near the lesion, in the morning and in the afternoon, every day except for the day when acupotomy was performed, during the admission period. The needles used were 0.
Herbal medicine was prescribed following the pattern diagnosis of the patient and 3 packages of herbal decoction (120 mL/package) were given per day to take 1 hour after a meal. The composition of herbal medicines prescribed for each patient during hospitalization are shown in Tables 1, 2.
The ROM of the lumbar spine, and the physical examination were Flexion 60° (+), Extension 30° (+), Lateral bending 35°/35°, Rotation 45°/45°, and SLR 60° (+)/70° (+), showing improvement in the ROM of flexion and extension, and the angle of SLR test (Fig 4, Table 4).
Acupotomy has been shown to decrease pain [3-5], but to date there has not been a Korean clinical case reported that has compared radiological evidence of change before and after acupotomy using CT or MRI imaging. This study showed radiological change in the improvement of herniated disc symptoms in addition to NRS scores of pain severity, which decreased for both patients (cervical and lumbar HNP), when acupotomy and combined Korean Medicine treatment was performed.

대상 데이터

Acupuncture points were located in a supine position. GV14, GV16, GB12, and GB20 were selected for cervical HNP, and GV03, BL23, BL24, and BL25 were selected for lumbar HNP. Intervention was performed on the adhesive area, and the hard area of the soft tissue of the erector spinae muscle, near the acupuncture points.
In Case 1, Soyeom pharmacopuncture was prescribed and bee venom B4 was prescribed for Case 2. Hard areas on BL23, BL24, BL25, and BL26 on both sides of the lumbar spine and BL10, BL11, and GB21 on both sides of the cervical spine were selected, and 0.5 mL of the pharmacopuncture agent was injected on an acupoint, a total of 1 mL per session.
The cervical spine MRI was taken on June 12, 2017 at the Department of Radiology at a local clinic. The image showed moderate extrusion to the left paracentral direction at C6-7 level, which compressed the dural sac (Fig.
The lumbar spine MRI was taken at the Department of Radiology of a local clinic on October 13, 2017. The image showed a large extrusion of disc, with superior migration at L4-5 level, which compressed the central canal, and the right side of the nerve root (Fig.
The needles used were 0.20 × 30, or 0.25 × 30 mm disposable filiform needles, sterilized by gamma rays (DongBang Medical Ltd., Korea).
The patient was admitted to the Dunsan Korean Medicine hospital from June 12, 2017 to June 16, 2017 for 5 days.
The patient was hospitalized from October 8, 2017, to November 4, 2017 for 28 days.

성능/효과

This is because the ROM limitation of the neck was not severe at the beginning of the treatment, and 3 sessions of acupotomy during 5-day hospitalization was not enough to fully induce healing response after microtrauma. On the contrary, in Case 2, both radiological change in the follow-up MRI after 9 months, improvement in the ROM, and the NRS score of lower back and right limb pain at discharge were observed after 7 sessions of acupotomy during 28-day hospitalization.
Afterwards, MRI was taken on July 2, 2018 at the same clinic. The findings showed that the HNP at C6-7 level was reabsorbed considerably and improved to a mild protrusion state with decreased compression on the dural sac (Fig. 3).

후속연구

Therefore, the radiological changes of the herniated disc could not be entirely attributed to the effect of acupotomy treatment. Nevertheless, the value of this case study was to provide preliminary data on the radiological changes after acupotomy treatment, which may be a reference in future studies comparing natural changes with post-acupotomy changes.

참고문헌 (17)

Yun JY, Kim DH, Kim HW, Kim SS, Park SW, Kim EK et al. The Clinical Effects of Acupuncture and Acupotomy Therapy for HIVD. J Korean Acupunct Moxib Soc 2010;27:85-97. [in Korean].
The Institute of Korean Acupotomy Medicine. Acupotomy. Seoul (Korea): Jeongdam; 2003. p. 81-2, 87, 111, 113, 127.
Kim EK, Kim HW, Lee GH, Lee GM. The Clinical Study on Effects of Acupotomy Therapy in Patients with Cervical Herniated Intervertebral Disc. J Korean Acupunct Moxib Soc 2009;26:71-77. [in Korean].
Sung IS, Yuk DI, Song DH, Kim MJ, Hong KE. Case Study of with Dochim & Gwanchim Therapy Combined with Korean Medicine Treatment of Herniated Lumbar Intervertebral Disc Patients. J Acupunct Res 2013;30:169-173. [in Korean].
Kim HS, Kim SY, Kim HJ, Kim ES, Kim YI. The Effect of Acupotomy on Lumbar Herniated Intervertebral Disc: Report of a Case Series. J Acupunct Res 2015;32:185-195. [in Korean].

원문보기 상세보기
Kim SY, Kim HJ, Ji YS, Lee SM, Kim YI. The Effect of Acupotomy on Lumbar and Cervical Spine Combined with Oriental Medical Treatment: Report of Five Cases. J Acupunct Res 2014;31:183-193. [in Korean].

원문보기 상세보기
Hawker GA, Mian S, Kendzerska T, French M. Measures of Adult Pain. Arthritis Care Res (Hoboken) 2011;63:240-252.

상세보기
Esses SI Textbook of spinal disorders. Seoul (Korea): Koonja; 2008. 12 p.
Kim DJ. Pathophysiology of Degenerative Cervical Spinal Disease. J Korean Spine Surg 1999;6:173-180. [in Korean].
Yuk DI, Song I, Ko MK, Sung IS, Kim MJ, Lee JW et al. Five Cases of Frozen Shoulder Patients Treated by Acupotomy Combined with Oriental Medical Treatments. J Acupunct Res 2012;29:167-176. [in Korean].
Song I, Hong KE. The Comparison between Acupotomy Therapy and Epidural Neuroplastic (Lumbar Vertebra). J Acupunct Res 2010;27:9-18. [in Korean].
Yuk DI, Kim KM, Jeon JH, Kim YI, Kim JH. A Review of Trends for Acupotomy. J Acupunct Res 2014;31:35-43. [in Korean].
Yoo SB, Kim MH, Moon BH, Yoon TK, Ju YG, Kwon OJ et al. Forty-One Cases on MRI Change of Hivd of L-spine Patinet Who Have Been Improvement on Megadose Pharmacoacupuncture and Korean Medical Treatments. J Korean Med Rehabil 2016;26:117-126. [in Korean].

원문보기 상세보기
Lee SH, Lee GM, Lee KS, Lee DY, Chang HH, Kim YJ. Case Report on absorption of extruded disc in extrusion type HNP of L-spine patient treated by Oriental Medicine Treatment with Bee Venom Acua-Acupuncture therapy. J Acupunct Res 2003;20:100-108. [in Korean].
Chung B, Chung SH, Lee JS. Magnetic Resonance Imaging Follow-Up Study on the Case of Protruded Lumbar Intervertebral Disc Herniation through Chuna Therapy. J Oriental Rehab Med 2006;16:149-157. [in Korean].
Korea Institute of Oriental Medicine. KMCPG-Lumbar Herniated Intervertebral Disc (HIVD). Seoul (Korea): Elsevier Korea LLC; 2015. 38 p.
Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: A systemic review. Clin Rehabil 2015;29:184-195.

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Cervical and Lumbar Herniated Nucleus Pulposus Resorption after Acupotomy with Integrative Korean Medicine Treatment: A Case Series of Two Patients 원문보기

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Cervical and Lumbar Herniated Nucleus Pulposus Resorption after Acupotomy with Integrative Korean Medicine Treatment: A Case Series of Two Patients 원문보기

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