A Case Report of Cervical Myelopathy Caused by Ossification of Posterior Longitudinal Ligament: Focusing on Warm Needling Therapy

Article information

Acupunct. 2014;31(3):75-82
Publication date (electronic) : 2014 September 20
doi : https://doi.org/10.13045/acupunct.2014045
Department of Acupuncture & Moxibustion Medicine, Graduate School of Korean Medicine, Kyung Hee University
*Corresponding author : Department of Acupuncture & Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, Republic of Korea, Tel : +82-2-958-9205, E-mail : choi4532@unitel.co.kr
Received 2014 August 11; Revised 2014 September 04; Accepted 2014 September 05.

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.

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.

Fig. 3.

Change in VAS scores of numbness and hyperesthesia

Fig. 4.

Change in grip and release test results

Japanese Orthopedic Association Score (JOA score)

Level of Satisfaction

Change in Finger Escape Sign Test Results

Change in JOA Score

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.
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.
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.
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.
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.
10. Choi BW, Song KJ. Ossification of the posterior longitudinal ligament: a review of literature. Asian Spine Journal 2011;5(4):267–76.
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.
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.
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.
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.
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.

Article information Continued

Fig. 1.

Sagittal view of cervical spine MRI

T2-MRI shows high signal intensity area at C6–7 level of spinal cord.

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.

Fig. 3.

Change in VAS scores of numbness and hyperesthesia

Fig. 4.

Change in grip and release test results

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