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J Acupunct Res > Volume 31(3); 2014 > Article
Lee, Yoon, Lim, Cho, Park, Nam, and Choi: A Case Report of Cervical Myelopathy Caused by Ossification of Posterior Longitudinal Ligament: Focusing on Warm Needling Therapy
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Abstract

Objectives :

The purpose of this study is to investigate the effects of warm needling therapy in a patient with cervical myelopathy caused by ossification of posterior longitudinal ligament.

Methods :

A 53-year-old Korean male patient diagnosed with cervical myelopathy due to ossification of posterior longitudinal ligament was treated with warm needling therapy on posterior neck aside from the routine inpatient treatment from June 26th to July 16th. Clinical improvement was evaluated with visual analogue scale (VAS), Japanese orthopedic score (JOA), grip and release test, finger escape sign and patient satisfaction was measured using a five-point Likert scale.

Results :

After 21 days of treatment, the patient showed improvement in VAS, JOA, grip and release test and finger escape sign. The patient also expressed satisfaction with the treatment.

Conclusions :

The results suggest that warm needling therapy may be an effective additional treatment for cervical myelopathy and other symptoms related to ossification of posterior longitudinal ligament (OPLL). Further studies should be carried out regarding possible long-lasting effects.

Fig. 1.
Sagittal view of cervical spine MRI
T2-MRI shows high signal intensity area at C6–7 level of spinal cord.
acupunct-31-3-75f1.gif
Fig. 2.
Features of warm needling therapy
First, acupuncture needle is inserted at the acupuncture point (A).
Then, moxa stick (B) is placed by sliding it onto the needle through the hole in the middle.
acupunct-31-3-75f2.gif
Fig. 3.
Change in VAS scores of numbness and hyperesthesia
acupunct-31-3-75f3.gif
Fig. 4.
Change in grip and release test results
acupunct-31-3-75f4.jpg
Table 1.
Japanese Orthopedic Association Score (JOA score)
Upper extremity function 0. Impossible to eat with either chopsticks or spoon
1. Possible to eat with spoon, but not chopsticks
2. Possible to eat with chopsticks, but inadequate
3. Possible to eat with chopsticks, but awkward
4. Normal

Lower extremity function 0. Impossible to walk
1. Need cane or aid on flat ground
2. Need cane or aid only on stairs
3. Possible to walk without cane or aid, but slow
4. Normal

Sensory A.Upper extremity 0. Apparent sensory loss
1. Minimal sensory loss
2. Normal

B.Lower extremity 0. Apparent sensory loss
1. Minimal sensory loss
2. Normal

C.Trunk 0. Apparent sensory loss
1. Minimal sensory loss
2. Normal

Bladder function 0. Complete retention

1.Severe disturbance 0. Inadequate evacuation of the bladder
1. Straining
2. Dribbling

2. Mild disturbance 1. Urinary frequency
2. Urinary hesitance

3. Normal
Table 2.
Level of Satisfaction
Score Item

5 Very satisfactory
4 Satisfactory
3 Normal
2 Dissatisfactory
1 Very dissatisfactory
Table 3.
Change in Finger Escape Sign Test Results
June July
26 28 30 2 4 6 8 10 12 14 16
Right
Left + + + + + + ± ±
Table 4.
Change in JOA Score
Date 6. 26 7. 2 7. 9 7. 16
Score 8 9 9 9

VI. References

1. Kang YK, Cheong SC. Ossification of posterior longitudinal ligament of the cervical spine in Korean. The J of Korean Orthopaedic Association. 1991;26(5):1508–13.
crossref
2. Lee YR, Shin HK. Study of ossification of posterior longitudinal ligament (OPLL). Daejon University Institute of Oriental Medicine. 2007;16(1):147–56.

3. Lee SH, Lee SW, Kim YJ, et al. Clinical observation of improvement made by moxibustion on a case of myelopathy-hand patient caused by cervical myelopathy. The J of Korean Acupuncture & Moxibustion Society. 2009;26(6):251–60.
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4. Kwon HY, Kim JH. Clinical study on a case of cervical myelopathy with additional scolopendrae corpus pharmacopuncture. Journal of Meridian & Acupoint. 2009;26(4):225–35.
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5. Ko YS, Lee JH, Park TY, et al. A case report on the ossification of the posterior longitudinal ligament of the cervical spine. The J of Korea Chuna Manual Medicine for Spine & Nerves. 2005;6(1):157–67.
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6. Lee JB, Lee HY. A case report on cervical spinal stenosis with ossification of posterior longitudinal ligament applied chuna treatment. The J of Korea Chuna Manual Medicine for Spine & Nerves. 2009;4(1):85–94.

7. Park SW, Kim SS. The clinical effects of acuptomy for ossification of the posterior longitudinal ligament. The J of Korean Acupuncture & Moxibustion Society. 2011;28(4):127–35.

8. Terayama K, Maruyama S, Miyoshita R, et al. Ossification of the posterior longitudinal ligament in the cervical spine. Orthop Surg. 1964;15:1083–95.

9. Tsuyama N. Ossification of the posterior longitudinal ligament of the spine. Clin Orthop Relat Res. 1984;184:71–84.
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10. Choi BW, Song KJ. Ossification of the posterior longitudinal ligament: a review of literature. Asian Spine Journal. 2011;5(4):267–76.
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11. Lee OJ, Yoon MY. Clinical study on a case of cervical myelopathy. The J of Korean Acupuncture & Moxibustion Society. 2003;20(4):220–9.

12. Kim JU, Choi SY. Clinical studies on ossification of ligament within spinal canal. The J of Korean Acupuncture & Moxibustion Society. 2004;21(6):127–49.
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13. Chiba K, Yamamoto I, Hirabayashi H, et al. Multi-center study investigating the postoperative progression of ossification of the posterior longitudinal ligament in the cervical spine: a new computer-assisted measurement. J Neurosurg Spine. 2005;3(1):17–23.
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14. Park KH, Lee H. Consideration of literatures on the treatment of pain in shoulder and arm based on oriental medicine and western medicine. Daejon University Institute of Oriental Medicine. 2006;15(1):59–69.

15. Chung JY, Choi DY. Review of clinical trials on warming acupuncture for musculoskeletal pain diseases : A systematic review. The J of Korean Acupuncture & Moxibustion Society. 2009;26(4):11–8.
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16. Min WK, Yeo SJ, Kim EH, et al. Comparison of warm-needling and acupuncture for knee osteoarthritis: a randomized controlled trial. Korean Journal of Acupuncture. 2013;30(1):64–72.
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17. Jung JY, Kim YI. The clinical study 5 cases through hot acupuncture for treating the carpal tunnel syndrome. Daejon University Institute of Oriental Medicine. 2010;19(1):9–15.

18. Park SG, Choi WS. A clinical study on low back pain patients with warming acupuncture therapy. J of Oriental Rehabilitation Medicine. 2005;15(1):123–38.

19. Ahn SG, Lee SR. The treatise research on Hua-Tuo-Jia-Ji-Xue (華佗夾脊穴). The J of Korean Acupuncture & Moxibustion Society. 2000;17(4):139–48.

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