Journal of Acupuncture Research 2025; 42:46-52
Published online January 23, 2025
https://doi.org/10.13045/jar.24.0050
© Korean Acupuncture & Moxibustion Medicine Society
Correspondence to : Ji-Sun Kim
Department of Acupuncture and Moxibustion, Jaseng Hospital of Korean Medicine, 536 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea
E-mail: lovemintk@naver.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The transverse processes function as essential attachment points for the muscles and ligaments surrounding the spine, and transverse process fractures (TPF) are commonly observed in trauma patients, such as those involved in traffic accidents. However, studies investigating the effectiveness of integrated Korean medicine (iKM) treatments for lumbar TPF have been limited. The present study aims to report a case of a traffic accident-induced lumbar TPF treated with iKM, which indicated significant improvement in pain and function. The patient was diagnosed with left TPFs at the L3 and L4 vertebral levels via radiological examination and underwent iKM treatments. After two weeks of iKM hospitalization, the numerical rating scale scores decreased from 5 to 3, the Oswestry Disability Index scores decreased from 53.33 to 35.56, and the EuroQoL-5 dimension scores increased from 0.675 to 0.771. In conclusion, our findings suggest that iKM treatments may be effective for patients with lumbar TPF in terms of pain and functional management.
Keywords Case reports; Integrated Korean medicine treatment; Lumbar transverse process fracture
Transverse processes are bony projections found on the lateral aspects of the spinal vertebrae. Transverse process fractures (TPF) commonly occur in patients with multiple traumas and may present as isolated injuries or alongside other vertebral fractures affecting the lamina, pedicle, facet joint, or vertebral body [1,2].
Within the framework of the thoracolumbar injury classification, TPF was initially categorized as a minor injury [3]. However, research from trauma centers has suggested that the impact of TPF on spinal dynamics may be more significant than previously thought, which is often more severe than the other types of spinal injuries, despite being frequently underestimated [4]. In many instances, patients are discharged from emergency care with prescriptions for pain management, typically including medications such as paracetamol [5].
Owing to the recent increase in the number of traffic accidents and industrial accidents, the cases of spinal fractures have increased, and the introduction of surgical treatment using metal fixation for vertebral fractures has led to several changes and developments. However, if the fracture is overlooked or unstable fractures are not properly treated, the patients will have poor treatment results [6].
Although many conservative treatments have been performed on TPF cases due to traffic accidents, research on the effectiveness of integrated Korean medicine (iKM) treatments for TPF has been limited. Therefore, we report a case of lumbar TPF caused by a traffic accident whose symptoms improved with iKM treatment.
This study included a 41-year-old female who developed pain from both sides of the lower back to the pelvis after a car accident that occurred while she was riding on a bus on April 22, 2024. She presented with pain and bruising on the left side of her lower back. She had no relevant family history or history of medication use. She visited the hospital for the first time on April 26, 2024, without any treatment history, and was hospitalized from April 29 to May 12.
The radiography scan (on April 26, 2024) of the lower back performed on the first day of visit indicated TPFs at the left L3 and L4 vertebral levels (Fig. 1). Magnetic resonance imaging (MRI) was performed three days later (on April 29, 2024) for additional diagnosis, but no special problems were observed except for TPFs at the left L3 and L4 vertebral levels (Fig. 2).
Acupuncture was used for pain management (Table 1).
Table 1 . Summary table of interventions used in this study according to the Standard for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA)
Item | Detail | |
---|---|---|
1. Acupuncture rationale | 1a) Style of acupuncture | Traditional Korean acupuncture |
1b) Reasoning for the treatment provided | Literature and clinical experience of experts | |
2. Details of needling | 2a) Number of needle insertions per subject per session | From 5 to 10 |
2b) Name of points used | Huatuo Jiaji (EX-B2) points (low back), GV3 (Yaoyangguan) acupoint | |
2c) Depth of insertion | 30–35 mm | |
2d) Response sought | Acupuncture sensation “De qi” | |
2e) Needle stimulation | Manual stimulation | |
2f) Needle retention time | At once | |
2g) Needle type | Sterile 0.25 × 40 mm stainless needles (Dongbang Acupuncture Inc.) | |
3. Treatment regimen | 3a) Number of treatment sessions | 28 |
3b) Frequency and duration of the treatment sessions | Twice a day for 10–15 min (14 d) | |
4. Other components of the treatment | 4a) Details of other interventions administered to the acupuncture group (e.g., moxibustion, cupping, herbs, exercises, lifestyle advice) | Herbal medicine, cupping therapy, and electronic moxibustion |
4b) Setting and context of the treatment, including instructions to practitioners and information and explanations to patients | Procedure of the treatments | |
5. Practitioner background | 5a) Description of the participating acupuncturists (qualification of professional affiliation, years in acupuncture practice, other relevant experience) | Korean medicine doctor of the acupuncture and moxibustion department with more than 6 months of experience |
6. Control or comparator interventions | 6a) Rationale for the control or comparator in the context of the research question, with sources that justify this choice | No control or comparator interventions |
6b) Precise description of the control or comparator. If sham acupuncture or any other type of acupuncture-like control is used, provide details as for Items 1 to 3 above | No control or comparator interventions |
The patient was also treated with Shinbaro 2 pharmacopuncture (Jaseng Wonoe Tangjunwon) once a day (2 mL/day) using a 1-mL insulin syringe with a disposable needle (29 gauge × 13 mm). The needles were inserted into a depth of 1 cm, and the drug was administered at 0.5 mL per BL25 acupoint. To prevent infection, the treatment site was disinfected with a 10% povidone-iodine solution before and after the procedure (Table 2).
Table 2 . Contents of the Shinbaro-pharmacopuncture used in this study
Pharmacopuncture prescription | Herbal medicine components (g/mL) | Administered | Daily dose |
---|---|---|---|
SJ3-SBO Shinbaro 2 | Paeonia lactiflora (0.0027) Ostericum koreanum (Max) Kitagawa (0.0013) Aralia continentalis (0.0013) Cortex Eucommiae (0.0013) Achyranthis Radix (0.0013) Rhizoma Cibotii (0.0013) Radix Ledebouriellae (0.0013) Acanthopanacis Cortex (0.0013) Scolopendra subspinipes mutilans (0.0013) | Day 1 to day 14 | 1 vial (2 mL/vial) |
Dangguisusan-gamibang, which is used to treat patients with trauma injuries, was prescribed twice daily. Table 3 shows the herbal components, daily doses, and schedules.
Table 3 . Herbal medicine prescriptions
Herbal prescription | Herbal medicine components (g/pouch) | Administered | Daily dose |
---|---|---|---|
Dangguisusan-gamibang | Angelicae Gigantis Radix (4.000) Paeoniae Radix Rubra (3.200) Linderae Radix (3.200) Cyperi Rhizoma (3.200) Caesalpinia Lignum (3.200) Carthami Flos (3.200) Persicae Semen (2.800) Cinnamon bark (2.400) Glycyrrhizae Radix et Rhizoma (2.000) Harpagophytum procumbens (2.000) Drynaria fortune (2.000) Roots of Asarum sieboldii (1.200) | Day 1 to day 14 | Two pouches |
Transcutaneous infrared irradiation therapy was also applied for 10–15 minutes. Wet cupping therapy applied to the lumbar region and indirect moxibustion therapy were performed for 5–10 minutes twice a day, mainly in the governor vessel and EX-B2 acupoints. For this procedure, sterilized plastic cups (Dongbang Medical Co., Ltd.) and electronic moxibustion (Orange Medical Co., Ltd.) were utilized.
The numerical rating scale (NRS), Oswestry Disability Index (ODI), and EuroQoL-5 dimension (EQ-5D) were used to evaluate the patient’s lower back pain, functional disability, and quality of life. The NRS pain assessment was conducted at 08:00 AM daily from the day of hospitalization. The ODI and EQ-5D were confirmed by evaluating the hospitalization and discharge dates. The patient’s range of motion (ROM) was evaluated to analyze the mobility of a particular joint. Specifically, we measured the lumbar spine’s movement for flexion, extension, lateral bending, and rotation.
Upon admission, the patient had an NRS score of 5 for lower back pain, ODI score of 53.33, and EQ-5D score of 0.675. Lumbar spine ROM was noted as flexion of 10, extension of 5, and lateral bending of 20 bilaterally. Both the results of the straight leg raise test and Patrick tests were inconclusive due to pain. On the ninth day of hospitalization, the NRS score decreased to 4. On the discharge day (the 14th day of hospitalization), the NRS score further decreased to 3, ODI score decreased to 35.56, and EQ-5D score was 0.771 (Figs. 3–5). Moreover, the ROM had slightly improved to a flexion of 60, extension of 10, and lateral bending of 30 bilaterally (Table 4). During hospitalization, no adverse events were observed.
Table 4 . Summary table of changes in lumbar range of motion at admission and discharge
Date | Flexion (°) | Extension (°) | The lat. bending (°) | Rotation (°) | |||
---|---|---|---|---|---|---|---|
Rt | Lt | Rt | Lt | ||||
2024.04.29 | 10 | 5 | 20 | 20 | 45 | 45 | |
2024.05.12 | 60 | 10 | 30 | 30 | 45 | 45 |
lat., lateral; Rt, right; Lt, left.
It has not been determined whether a surgical approach is needed in the treatment for TPF [7]. It was also suggested that the management of the aftereffects related to instability in the future is important as it can cause symptoms related to unexpected but clinically important spinal instability if adequate treatment is not performed [8].
Our case report presented a case of lumbar TPF in a patient hospitalized for a short period of time whose pain and physical function improved with iKM treatments. Acupuncture can relieve pain clinically in the injured area and mediate analgesia through the administration of opioid peptides and their receptors. Moreover, it is also commonly used for managing both acute and chronic pain [9]. Shinbaro-pharmacopuncture involves an extract purified from a mixture of six traditional Korean herbal medicines (Table 2) that have been traditionally used for treating various inflammatory and bone diseases. When injected into the fracture sites, this treatment can suppress inflammation, relieve pain, and improve functioning [10]. Dangguisusan-gamibang is an herbal medicine that is an enhanced version of Dangguisusan with the addition of Harpagophytum procumbens, Drynaria fortunei, and the roots of Asarum sieboldii (Table 3). Moreover, Dangguisusan tends to inhibit inflammatory mediators, including nitric oxide, interleukin-1β, interleukin-6, and tumor necrosis factor-α, and decrease the appearance of subcutaneous hematomas, such as bruises [11]. The analgesic and anti-inflammatory effects are amplified by the addition of three specific herbs [12-14]. While a prior case report has emphasized the anti-inflammatory benefits of the combined treatment with Shinbaro-pharmacopuncture and Dangguisusan [15], further research is needed to establish robust scientific evidence.
A literature review on the treatment of traumatic TPF was conducted using the PubMed database (Supplementary Table 1, Supplementary Fig. 1). A total of 14 articles were identified, of which 9 were case reports, while the rest were mainly articles in the form of a retrospective review (Supplementary Table 2). In Supplementary Table 2, medications, such as corset, brace, nonsteroidal anti-inflammatory drugs, or muscle relaxants, were often used rather than a surgical approach. Some studies have also focused on conservative therapies such as medication or braces. However, considering the economic burden caused by spine service intervention, including general nonsurgical therapy, unnecessary financial burdens have been reported [16]. Varma et al. [17] suggested that the evidence on bracing is limited, emphasizing the need for further research on its impact on patient outcomes, cost-effectiveness, and cognitive function. A systematic review and meta-analysis also revealed that bracing offers no benefit in the conservative treatment of acute thoracolumbar fractures [18]. Furthermore, when considering the side effects of medications, iKM may have advantages for TPF patients.
However, our study has several limitations. First, as a case report, it lacked a control group, which makes it difficult to determine whether the patient’s outcomes were directly related to the treatment, resulting in a relatively low level of evidence. Second, follow-up MRI scans are needed to further evaluate the patient’s outcomes after treatment.
Nevertheless, the findings of this study hold significance as it determined the effectiveness of iKM treatment for lumbar TPF caused by a traffic accident. Our results suggest that iKM treatments could be an alternative conservative treatment for lumbar TPF. Further research with control groups and extended follow-up periods are needed to confirm iKM’s effectiveness and potential for a broader clinical application in TPF treatment.
Conceptualization: JSK, GBL, HWC. Formal analysis: All authors. Investigation: JSK, DYK, DJK, DJY. Methodology: JSK, JSY, IJC. Writing - original draft: JSK, YRY. Writing - review and editing: All authors.
The authors have no conflicts of interest to declare.
None.
This study did not include any human or animal experimentation; therefore, it was exempt from obtaining ethical approval.
Supplementary data is available at https://doi.org/10.13045/jar.24.0050 .
jar-42-46-supple.pdfJournal of Acupuncture Research 2025; 42(): 46-52
Published online January 23, 2025 https://doi.org/10.13045/jar.24.0050
Copyright © Korean Acupuncture & Moxibustion Medicine Society.
Ji-Sun Kim , Gyu-Bin Lee
, Hong-Wook Choi
, Do-Young Kim
, Dong-Jin Kim
, Dong-Ju Yoon
, Ye-Rim Yun
, Ji-Sung Yeum
, Ik-Jun Cho
Department of Acupuncture and Moxibustion, Jaseng Hospital of Korean Medicine, Seoul, Korea
Correspondence to:Ji-Sun Kim
Department of Acupuncture and Moxibustion, Jaseng Hospital of Korean Medicine, 536 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea
E-mail: lovemintk@naver.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The transverse processes function as essential attachment points for the muscles and ligaments surrounding the spine, and transverse process fractures (TPF) are commonly observed in trauma patients, such as those involved in traffic accidents. However, studies investigating the effectiveness of integrated Korean medicine (iKM) treatments for lumbar TPF have been limited. The present study aims to report a case of a traffic accident-induced lumbar TPF treated with iKM, which indicated significant improvement in pain and function. The patient was diagnosed with left TPFs at the L3 and L4 vertebral levels via radiological examination and underwent iKM treatments. After two weeks of iKM hospitalization, the numerical rating scale scores decreased from 5 to 3, the Oswestry Disability Index scores decreased from 53.33 to 35.56, and the EuroQoL-5 dimension scores increased from 0.675 to 0.771. In conclusion, our findings suggest that iKM treatments may be effective for patients with lumbar TPF in terms of pain and functional management.
Keywords: Case reports, Integrated Korean medicine treatment, Lumbar transverse process fracture
Transverse processes are bony projections found on the lateral aspects of the spinal vertebrae. Transverse process fractures (TPF) commonly occur in patients with multiple traumas and may present as isolated injuries or alongside other vertebral fractures affecting the lamina, pedicle, facet joint, or vertebral body [1,2].
Within the framework of the thoracolumbar injury classification, TPF was initially categorized as a minor injury [3]. However, research from trauma centers has suggested that the impact of TPF on spinal dynamics may be more significant than previously thought, which is often more severe than the other types of spinal injuries, despite being frequently underestimated [4]. In many instances, patients are discharged from emergency care with prescriptions for pain management, typically including medications such as paracetamol [5].
Owing to the recent increase in the number of traffic accidents and industrial accidents, the cases of spinal fractures have increased, and the introduction of surgical treatment using metal fixation for vertebral fractures has led to several changes and developments. However, if the fracture is overlooked or unstable fractures are not properly treated, the patients will have poor treatment results [6].
Although many conservative treatments have been performed on TPF cases due to traffic accidents, research on the effectiveness of integrated Korean medicine (iKM) treatments for TPF has been limited. Therefore, we report a case of lumbar TPF caused by a traffic accident whose symptoms improved with iKM treatment.
This study included a 41-year-old female who developed pain from both sides of the lower back to the pelvis after a car accident that occurred while she was riding on a bus on April 22, 2024. She presented with pain and bruising on the left side of her lower back. She had no relevant family history or history of medication use. She visited the hospital for the first time on April 26, 2024, without any treatment history, and was hospitalized from April 29 to May 12.
The radiography scan (on April 26, 2024) of the lower back performed on the first day of visit indicated TPFs at the left L3 and L4 vertebral levels (Fig. 1). Magnetic resonance imaging (MRI) was performed three days later (on April 29, 2024) for additional diagnosis, but no special problems were observed except for TPFs at the left L3 and L4 vertebral levels (Fig. 2).
Acupuncture was used for pain management (Table 1).
Table 1 . Summary table of interventions used in this study according to the Standard for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA).
Item | Detail | |
---|---|---|
1. Acupuncture rationale | 1a) Style of acupuncture | Traditional Korean acupuncture |
1b) Reasoning for the treatment provided | Literature and clinical experience of experts | |
2. Details of needling | 2a) Number of needle insertions per subject per session | From 5 to 10 |
2b) Name of points used | Huatuo Jiaji (EX-B2) points (low back), GV3 (Yaoyangguan) acupoint | |
2c) Depth of insertion | 30–35 mm | |
2d) Response sought | Acupuncture sensation “De qi” | |
2e) Needle stimulation | Manual stimulation | |
2f) Needle retention time | At once | |
2g) Needle type | Sterile 0.25 × 40 mm stainless needles (Dongbang Acupuncture Inc.) | |
3. Treatment regimen | 3a) Number of treatment sessions | 28 |
3b) Frequency and duration of the treatment sessions | Twice a day for 10–15 min (14 d) | |
4. Other components of the treatment | 4a) Details of other interventions administered to the acupuncture group (e.g., moxibustion, cupping, herbs, exercises, lifestyle advice) | Herbal medicine, cupping therapy, and electronic moxibustion |
4b) Setting and context of the treatment, including instructions to practitioners and information and explanations to patients | Procedure of the treatments | |
5. Practitioner background | 5a) Description of the participating acupuncturists (qualification of professional affiliation, years in acupuncture practice, other relevant experience) | Korean medicine doctor of the acupuncture and moxibustion department with more than 6 months of experience |
6. Control or comparator interventions | 6a) Rationale for the control or comparator in the context of the research question, with sources that justify this choice | No control or comparator interventions |
6b) Precise description of the control or comparator. If sham acupuncture or any other type of acupuncture-like control is used, provide details as for Items 1 to 3 above | No control or comparator interventions |
The patient was also treated with Shinbaro 2 pharmacopuncture (Jaseng Wonoe Tangjunwon) once a day (2 mL/day) using a 1-mL insulin syringe with a disposable needle (29 gauge × 13 mm). The needles were inserted into a depth of 1 cm, and the drug was administered at 0.5 mL per BL25 acupoint. To prevent infection, the treatment site was disinfected with a 10% povidone-iodine solution before and after the procedure (Table 2).
Table 2 . Contents of the Shinbaro-pharmacopuncture used in this study.
Pharmacopuncture prescription | Herbal medicine components (g/mL) | Administered | Daily dose |
---|---|---|---|
SJ3-SBO Shinbaro 2 | Paeonia lactiflora (0.0027) Ostericum koreanum (Max) Kitagawa (0.0013) Aralia continentalis (0.0013) Cortex Eucommiae (0.0013) Achyranthis Radix (0.0013) Rhizoma Cibotii (0.0013) Radix Ledebouriellae (0.0013) Acanthopanacis Cortex (0.0013) Scolopendra subspinipes mutilans (0.0013) | Day 1 to day 14 | 1 vial (2 mL/vial) |
Dangguisusan-gamibang, which is used to treat patients with trauma injuries, was prescribed twice daily. Table 3 shows the herbal components, daily doses, and schedules.
Table 3 . Herbal medicine prescriptions.
Herbal prescription | Herbal medicine components (g/pouch) | Administered | Daily dose |
---|---|---|---|
Dangguisusan-gamibang | Angelicae Gigantis Radix (4.000) Paeoniae Radix Rubra (3.200) Linderae Radix (3.200) Cyperi Rhizoma (3.200) Caesalpinia Lignum (3.200) Carthami Flos (3.200) Persicae Semen (2.800) Cinnamon bark (2.400) Glycyrrhizae Radix et Rhizoma (2.000) Harpagophytum procumbens (2.000) Drynaria fortune (2.000) Roots of Asarum sieboldii (1.200) | Day 1 to day 14 | Two pouches |
Transcutaneous infrared irradiation therapy was also applied for 10–15 minutes. Wet cupping therapy applied to the lumbar region and indirect moxibustion therapy were performed for 5–10 minutes twice a day, mainly in the governor vessel and EX-B2 acupoints. For this procedure, sterilized plastic cups (Dongbang Medical Co., Ltd.) and electronic moxibustion (Orange Medical Co., Ltd.) were utilized.
The numerical rating scale (NRS), Oswestry Disability Index (ODI), and EuroQoL-5 dimension (EQ-5D) were used to evaluate the patient’s lower back pain, functional disability, and quality of life. The NRS pain assessment was conducted at 08:00 AM daily from the day of hospitalization. The ODI and EQ-5D were confirmed by evaluating the hospitalization and discharge dates. The patient’s range of motion (ROM) was evaluated to analyze the mobility of a particular joint. Specifically, we measured the lumbar spine’s movement for flexion, extension, lateral bending, and rotation.
Upon admission, the patient had an NRS score of 5 for lower back pain, ODI score of 53.33, and EQ-5D score of 0.675. Lumbar spine ROM was noted as flexion of 10, extension of 5, and lateral bending of 20 bilaterally. Both the results of the straight leg raise test and Patrick tests were inconclusive due to pain. On the ninth day of hospitalization, the NRS score decreased to 4. On the discharge day (the 14th day of hospitalization), the NRS score further decreased to 3, ODI score decreased to 35.56, and EQ-5D score was 0.771 (Figs. 3–5). Moreover, the ROM had slightly improved to a flexion of 60, extension of 10, and lateral bending of 30 bilaterally (Table 4). During hospitalization, no adverse events were observed.
Table 4 . Summary table of changes in lumbar range of motion at admission and discharge.
Date | Flexion (°) | Extension (°) | The lat. bending (°) | Rotation (°) | |||
---|---|---|---|---|---|---|---|
Rt | Lt | Rt | Lt | ||||
2024.04.29 | 10 | 5 | 20 | 20 | 45 | 45 | |
2024.05.12 | 60 | 10 | 30 | 30 | 45 | 45 |
lat., lateral; Rt, right; Lt, left..
It has not been determined whether a surgical approach is needed in the treatment for TPF [7]. It was also suggested that the management of the aftereffects related to instability in the future is important as it can cause symptoms related to unexpected but clinically important spinal instability if adequate treatment is not performed [8].
Our case report presented a case of lumbar TPF in a patient hospitalized for a short period of time whose pain and physical function improved with iKM treatments. Acupuncture can relieve pain clinically in the injured area and mediate analgesia through the administration of opioid peptides and their receptors. Moreover, it is also commonly used for managing both acute and chronic pain [9]. Shinbaro-pharmacopuncture involves an extract purified from a mixture of six traditional Korean herbal medicines (Table 2) that have been traditionally used for treating various inflammatory and bone diseases. When injected into the fracture sites, this treatment can suppress inflammation, relieve pain, and improve functioning [10]. Dangguisusan-gamibang is an herbal medicine that is an enhanced version of Dangguisusan with the addition of Harpagophytum procumbens, Drynaria fortunei, and the roots of Asarum sieboldii (Table 3). Moreover, Dangguisusan tends to inhibit inflammatory mediators, including nitric oxide, interleukin-1β, interleukin-6, and tumor necrosis factor-α, and decrease the appearance of subcutaneous hematomas, such as bruises [11]. The analgesic and anti-inflammatory effects are amplified by the addition of three specific herbs [12-14]. While a prior case report has emphasized the anti-inflammatory benefits of the combined treatment with Shinbaro-pharmacopuncture and Dangguisusan [15], further research is needed to establish robust scientific evidence.
A literature review on the treatment of traumatic TPF was conducted using the PubMed database (Supplementary Table 1, Supplementary Fig. 1). A total of 14 articles were identified, of which 9 were case reports, while the rest were mainly articles in the form of a retrospective review (Supplementary Table 2). In Supplementary Table 2, medications, such as corset, brace, nonsteroidal anti-inflammatory drugs, or muscle relaxants, were often used rather than a surgical approach. Some studies have also focused on conservative therapies such as medication or braces. However, considering the economic burden caused by spine service intervention, including general nonsurgical therapy, unnecessary financial burdens have been reported [16]. Varma et al. [17] suggested that the evidence on bracing is limited, emphasizing the need for further research on its impact on patient outcomes, cost-effectiveness, and cognitive function. A systematic review and meta-analysis also revealed that bracing offers no benefit in the conservative treatment of acute thoracolumbar fractures [18]. Furthermore, when considering the side effects of medications, iKM may have advantages for TPF patients.
However, our study has several limitations. First, as a case report, it lacked a control group, which makes it difficult to determine whether the patient’s outcomes were directly related to the treatment, resulting in a relatively low level of evidence. Second, follow-up MRI scans are needed to further evaluate the patient’s outcomes after treatment.
Nevertheless, the findings of this study hold significance as it determined the effectiveness of iKM treatment for lumbar TPF caused by a traffic accident. Our results suggest that iKM treatments could be an alternative conservative treatment for lumbar TPF. Further research with control groups and extended follow-up periods are needed to confirm iKM’s effectiveness and potential for a broader clinical application in TPF treatment.
Conceptualization: JSK, GBL, HWC. Formal analysis: All authors. Investigation: JSK, DYK, DJK, DJY. Methodology: JSK, JSY, IJC. Writing - original draft: JSK, YRY. Writing - review and editing: All authors.
The authors have no conflicts of interest to declare.
None.
This study did not include any human or animal experimentation; therefore, it was exempt from obtaining ethical approval.
Supplementary data is available at https://doi.org/10.13045/jar.24.0050 .
jar-42-46-supple.pdfTable 1 . Summary table of interventions used in this study according to the Standard for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA).
Item | Detail | |
---|---|---|
1. Acupuncture rationale | 1a) Style of acupuncture | Traditional Korean acupuncture |
1b) Reasoning for the treatment provided | Literature and clinical experience of experts | |
2. Details of needling | 2a) Number of needle insertions per subject per session | From 5 to 10 |
2b) Name of points used | Huatuo Jiaji (EX-B2) points (low back), GV3 (Yaoyangguan) acupoint | |
2c) Depth of insertion | 30–35 mm | |
2d) Response sought | Acupuncture sensation “De qi” | |
2e) Needle stimulation | Manual stimulation | |
2f) Needle retention time | At once | |
2g) Needle type | Sterile 0.25 × 40 mm stainless needles (Dongbang Acupuncture Inc.) | |
3. Treatment regimen | 3a) Number of treatment sessions | 28 |
3b) Frequency and duration of the treatment sessions | Twice a day for 10–15 min (14 d) | |
4. Other components of the treatment | 4a) Details of other interventions administered to the acupuncture group (e.g., moxibustion, cupping, herbs, exercises, lifestyle advice) | Herbal medicine, cupping therapy, and electronic moxibustion |
4b) Setting and context of the treatment, including instructions to practitioners and information and explanations to patients | Procedure of the treatments | |
5. Practitioner background | 5a) Description of the participating acupuncturists (qualification of professional affiliation, years in acupuncture practice, other relevant experience) | Korean medicine doctor of the acupuncture and moxibustion department with more than 6 months of experience |
6. Control or comparator interventions | 6a) Rationale for the control or comparator in the context of the research question, with sources that justify this choice | No control or comparator interventions |
6b) Precise description of the control or comparator. If sham acupuncture or any other type of acupuncture-like control is used, provide details as for Items 1 to 3 above | No control or comparator interventions |
Table 2 . Contents of the Shinbaro-pharmacopuncture used in this study.
Pharmacopuncture prescription | Herbal medicine components (g/mL) | Administered | Daily dose |
---|---|---|---|
SJ3-SBO Shinbaro 2 | Paeonia lactiflora (0.0027) Ostericum koreanum (Max) Kitagawa (0.0013) Aralia continentalis (0.0013) Cortex Eucommiae (0.0013) Achyranthis Radix (0.0013) Rhizoma Cibotii (0.0013) Radix Ledebouriellae (0.0013) Acanthopanacis Cortex (0.0013) Scolopendra subspinipes mutilans (0.0013) | Day 1 to day 14 | 1 vial (2 mL/vial) |
Table 3 . Herbal medicine prescriptions.
Herbal prescription | Herbal medicine components (g/pouch) | Administered | Daily dose |
---|---|---|---|
Dangguisusan-gamibang | Angelicae Gigantis Radix (4.000) Paeoniae Radix Rubra (3.200) Linderae Radix (3.200) Cyperi Rhizoma (3.200) Caesalpinia Lignum (3.200) Carthami Flos (3.200) Persicae Semen (2.800) Cinnamon bark (2.400) Glycyrrhizae Radix et Rhizoma (2.000) Harpagophytum procumbens (2.000) Drynaria fortune (2.000) Roots of Asarum sieboldii (1.200) | Day 1 to day 14 | Two pouches |
Table 4 . Summary table of changes in lumbar range of motion at admission and discharge.
Date | Flexion (°) | Extension (°) | The lat. bending (°) | Rotation (°) | |||
---|---|---|---|---|---|---|---|
Rt | Lt | Rt | Lt | ||||
2024.04.29 | 10 | 5 | 20 | 20 | 45 | 45 | |
2024.05.12 | 60 | 10 | 30 | 30 | 45 | 45 |
lat., lateral; Rt, right; Lt, left..
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