Cervical Spondylosis & Its

Homoeopathic Management

GUIDED BY:

PROF.(DR.) MANOJ YADAV

N.H.M.C.,LUCKNOW

SUBMITTED BY:

ABHAY SINGH

BATCH 2006

Cervical Spondylosis & Its

Homoeopathic Management

GUIDED BY:

PROF.(DR.) MANOJ YADAV

N.H.M.C.,LUCKNOW

SUBMITTED BY:

ABHAY SINGH

BATCH 2006

ACKNOWLEDGEMENT

I hereby take this opportunity to extend my gratitude to all the teachers at National Homoeopathic MedicalCollege, Lucknow without whose support and guidance completion of this project would not have been possible.

I thank my project in charge

Prof.(Dr.)Manoj Yadav for her guidance in making this project.

Above all I am indebted to

principal Dr.Vikrama Prasad without whose support I would not have been able to get this opportunity.

ABHAY SINGH Intern

(Batch 2006)

National

Homoeopathic Medical

College & Hospital

,Lucknow

Certificate by Guide

I hereby certify that Abhay Singh

of Batch 2006 has prepared his dissertation file on the topic allotted to him,“Cervical Spondylosis”under my guidance and up to my satisfaction.

During the course of preparation she showed keen interest in his work, I wish his success in life.

National Homoeopathic Medical College & Hospital , Lucknow

Certificate by Principal

This is to certify that intern Abhay Singh of Batch 2006 has properly completed his dissertation topic entitled “Cervical Spondylosis” under sincere guidance of Prof.(Dr.) Manoj Yadav, National Homoeopathic Medical College & Hospital , Lucknow. I wish him all the best & success in life.

(PRINCIPAL)National Homoeopathic

Medical College &

Hospital ,Lucknow

INDEX

Contents

Page number

1. INTRODUCTION

2. AIMS & OBJECTIVES

3. REVIEW OF LITERATURE

A. REVIEW OF GENERAL MEDICAL LITERATUREB.REVIEW OF HOMOEOPATHIC MEDICAL LITERATURE

4. MATERIAL & METHODS

5. MANAGEMENT & HOMOEOPATHIC TREATMENT

6. ANNEXUREA.CASE FORMATIONB.GRAPHSC. SYNOPSIS OF CASES

7. BIBLIOGRAPHY.

INTRODUCTION

The significance of a fact is measured by the capacity of the

observer. Every teacher or student of Homoeopathy sees the same

facts in the drugs but in his evaluation and experience he

emphasizes certain aspects which may be completely ignored by

another person. This is why the richness of our Homoeopathy is

increased by contributions of different masters.

It is not always, in the present state of our knowledge, that we can

give absolute, characteristic contrast. It is easy to differentiate

where remedies diverge; but difficult to nicely discriminate where

similar remedies converge, until their symptoms are almost

identical; and yet, just here individualization is most needed.

Failures arise first from defective judgment; secondly from

imperfect provings, thirdly from imperfect clinical reports; fourthly

from an imperfect comprehension of what symptoms should be

compared.

AIMS & OBJECTIVES

To see the place of deep acting and short acting medicines

in treatment.

To see Homoeopathic dosage directions.

To see miasmatic and constitutional background in the

treatment.

To see the auxiliary management in the treatment.

REVIEW OF LITERATURE

REVIEW OF GENERAL MEDICAL LITERATURE

ANATOMY OF CERVICAL VERTEBRAE

There are seven cervical vertebrae, out of which the third to sixth

are typical, while the 1st, 2nd and 7th are atypical.

TYPICAL CERVICAL VERTEBRAE

(A) The body

It is small and broader from side to side than from before

backwards. Its superior surface is concave transversely with

upward projecting lips on each side. The inferior surface is saddle

shaped, being convex from side to side and concave from before

backwards. The lateral borders are beveled and from synovial

joints with the projecting lips of the next lower vertebra. The

anterior border projects downwards and may hide the

intervertebral disc. The anterior and posterior surfaces resemble

those of other vertebrae.

(B) Vertebral foramen

It is larger than the body. It is triangular in shape because the

pedicles are directed backwards and laterally.

(C) Vertebral arch

The pedicles are directed backwards and laterally. The superior

and inferior vertebral notches are of equal size. The laminae are

relatively long and narrow, being thinner above than below. The

superior and inferior articular processes form articular pillars

which project laterally at the junction of the pedicle and the

lamina. The superior articular facets are flat. They are directed

backwards and upwards. The inferior articular facets are also flat

but are directed forwards and downwards.

The transverse processes are pierced by foramina transversaria.

Each process has anterior and posterior roots which end in

tubercles joined by the costotransverse bar. The costal element is

represented by the anterior root, the costotransverse bar and the

posterior tubercle. The anterior tubercle of the 6th cervical

vertebra is large and is called the carotid tubercle because the

common carotid artery can be compressed against it. The spine is

short and bifid.

ATTACHMENTS AND RELATIONS

(1) The anterior and posterior longitudinal ligaments are

attached to the upper and lower borders of the body in front and

behind, respectively. On each side of the anterior longitudinal

ligament the vertebral part of the longus colli is attached to the

anterior surface. The posterior surface has two or more foramina

for passage of basivertebral veins.

(2) The upper borders and lower parts of the anterior surfaces of

the lamina provide attachment to the ligament flava.

(3) The foramen transversarium transmits the vertebral artery,

the vertebral veins and a branch from the inferior cervical

ganglion. The anterior tubercles give origin to the scalenus

anterior, the longus capitis, and the oblique part of the longus

colli.

(4) The costotransverse bars are grooved by the anterior primary

rami of the corresponding cervical nerves.

(5) The posterior tubercles give origin to the scalenus medius

and posterior, the levator scapulae, the splenius cervicis, the

longitudinal cervicis and the iliocostalis cervicis.

(6) The spine gives origin to the deep muscles of the back of the

neck (interspinalis, semispinalis thoracis, spinalis cervicis and

multifidus.)

FIRST CERVICAL VERTEBRA

It is called the atlas. It is ring shaped. It has no body. It also has

no spine. The atlas has a short anterior arch, a long posterior

arch, right and left lateral masses and transverse processes.

The anterior arch is marked by a median anterior tubercle on its

anterior aspect. Its posterior surface bears an oval facet which

articulate with the dens.

The posterior arch forms about two fifths of the ring end is much

longer than the anterior arch. Its posterior surface is marked by a

median posterior tubercle. The upper surface of the arch is

marked (behind the lateral mass) by a groove.

Each lateral mass shows the following important features. Its

upper surface bears the superior articular facet. This articular

facet is elongated (forward and medially), concave and is directed

upwards and medially. It articulates with the corresponding

condyle to form an atlanto-occipital joint. The lower surface is

marked by the inferior articular facet. This facet is nearly circular,

more or less flat and is directed downwards, medially and

backwards. It articulates with the corresponding facet on the axis

vertebra to form an atlantoaxial joint. The medial surface of the

lateral mass is marked by a small roughened tubercle.

The transverse process projects laterally from the lateral mass. It

is unusually long and can be felt on the surface of the neck

between the angle of the mandible and the mastoid process. Its

long length allows it to act as an effective lever for rotatory

movements of the head. The transverse process is pierced by the

foramen transversarium.

ATTACHMENTS AND RELATIONS

(1) The anterior tubercle provides attachments to the anterior

longitudinal ligaments, and provides insertion to the upper

oblique part of the longus colli.

(2) The upper border of the anterior arch gives attachment to the

anterior atlanto-occipital membrane.

(3) The lower border of the anterior arch gives attachment to the

lateral fibers of the anterior longitudinal ligaments.

(4) The posterior tubercle provides attachment to the ligamentun

nuchae and gives origin to the rectus capitis posterior minor (on

each side).

(5) The groove on the upper surface of the posterior arch is

occupied by the vertebral artery and by the first cervical nerve.

Behind the groove the upper border of the posterior arc gives

attachment to the posterior atlanto-occipital membranes.

(6) The lower border of the posterior arch gives attachment to

the highest pair of ligamentum flava.

(7) The tubercle on the medial side of the lateral mass gives

attachment to the transverse ligament of the atlas.

(8) The anterior surface of the lateral mass gives origin to the

rectus capitis anterior.

(9) The transverse process gives origin to the rectus capitis

lateralis (upper surface anteriorly), the superior oblique (upper

surface posteriorly), the inferior oblique (lower surface of the tip),

the levator scapulae (lateral margin and lower border), the

splenius cervicis and the scalenus medius.

SECOND CERVICAL VERTEBRA

It is called the axis. It is identified by the presence of the dens

(odontoid process) which is a strong tooth like process projecting

upwards from the body. The den is usually believed to represent

the centrum (body) of the atlas which has fused with the centrum

of the axis.

(A) BODY AND DENS

The superior surface of the body is fused with the dens and is

encroached upon on each side by the superior articular facets.

The dens articulate anteriorly with the anterior arch of the atlas

and posteriorly with the transverse ligament of the atlas.

The inferior surface has a prominent anterior margin which

projects downwards. The anterior surface presents a median

ridge on each side of which there are hollowed out impressions.

(B) VERTEBRAL ARCH

The pedicles are concealed by the superior articular processes.

The inferior surface presents a deep and wide inferior vertebral

notch, placed in front of the inferior articular process. The

superior vertebral notch is very shallow and is placed on the

upper border of the lamina, behind the superior articular process.

The lamina is thick and strong. Each superior articular facet

occupies the upper surfaces of the body and of the massive

pedicle. Laterally it overhangs the foramen transversarium. It is a

large, flat, circular facet which is directed upwards and laterally.

It articulates with the inferior facet of the atlas vertebra to form

the atlanto-axial joint. Each inferior articular facet lies posterior

to the transverse process and is directed downwards and

forwards to articulate with the 3rd cervical vertebra.

The transverse processes are very small and represent the true

posterior tubercles only. The foramen transversarium is directed

upwards and laterally.

The spine is large, thick and very strong. Its tip is bifid,

terminating in two rough tubercles.

ATTACHMENTS

The dens provide attachment at its apex to the apical ligament

and on each side to the alor ligaments.

(1)The anterior surface of the body receives the insertion

of the longus colli. The anterior longitudinal ligament is

also attached to the anterior surface.

(2) The posterior surface of the body provides attachment,

from below upwards, to the posterior longitudinal

ligament, the membrana tectoria and the vertebral limb

of the cruciate ligament.

(3)The laminae provide attachment to the ligamentum

flava.

(4) The transverse process gives origin by its tip to the

levator scapulae, the scalenus medius (anteriorly) and

the splenius cervicis (posteriorly) . The intertransverse

muscles are attached to the upper and lower surfaces of

the process.

(5) The spine gives attachment to the ligamentum

nuchae; the semispinalis cervicis, the rectus capitis

posterior major, the inferior oblique; the spinalis

cervicis, the interspinalis and the multifidus.

SEVENTH CERVICAL VERTEBRA

It is also known as the vertebra prominent because of its long

spinous process, the tip of which can be felt through the skin at

the lower end of the nuchal furrow.

Its spine is thick, long and nearly horizontal. It is not bifid, but

ends in a tubercle.

The transverse processes are comparatively large in size; the

posterior root is longer than the anterior. The anterior tubercle is

absent. The foramen transversarium is relatively small,

sometimes double or may be entirely absent.

ATTACHMENTS

(1) The tip of the spine provides attachment to the

ligamentum nuchae, the trapezius, the rhomboideus

minor, the serratius posterior superior, the splanius

capitis, the semispinalis thoracis, the spinalis cervicis,

the interspinalis and the multifidus.

(2)Transverse process. The foramen transversarium

usually transmits only an accessory vertebral vein. The

posterior tubercle provides attachment to the

suprapleural membrane. The lower border provides

attachment to the levator costarum.

(3) The anterior root of the transverse process may

sometimes be separate. It then forms a cervical rib of

variable size.

TYPICAL CERVICAL JOINTS BETWEEN THE LOWER

SIX CERVICAL VERTEBRAE

These correspond in structure to typical intervertebral joints. The

only additional point to be noted is that in the cervical region the

supraspinous ligaments are replaced by the ligamentum nuchae.

The ligamentum nuchae is triangular in shape. Its apex lies at the

seventh cervical spine and its base at the external occipital crest.

Its anterior border is attached to cervical spines, while the

posterior border is free and provides attachment to the investing

layer of deep cervical fascia. The ligament gives origin to the

splenius, rhomboid and trapezius muscles.

SPECIAL JOINTS BETWEEN ATLAS, AXIS AND

OCCIPITAL BONE

(1) The atlanto-occipital and the atlanto-axial joints

are designed to permit free movements of the head on

the neck.

(2) The axis vertebra and the occipital bone are connected

together by very strong ligaments. Between these two

bones, the atlas is held like a washer. The axis of

movement between the atlas and skull is transverse,

permitting flexion and extension, where as the axis of

movement between the axis and atlas is vertical,

permitting rotation of the head.

ATLANTO-OCCIPITAL JOINTS

These are synovial joints of the ellipsoid variety.

ARTICULAR SURFACES:

Above: The occipital condyles, which are convex.

Below: The superior articular surfaces of the atlas vertebra.

These are concave. The articular surfaces are elongated, and are

directed forwards and medially.

LIGAMENTS:

(1) The fibrous capsule surrounds the joint. It is thick

posterolateral and thin anteromedially.

(2) The anterior atlanto-occipital membrane extends

from the anterior margin of the foramen magnum

above to the upper border of the anterior arch of the

atlas below. Laterally it is continuous with the

anterior part of the capsular ligament, and anteriorly

it is strengthened by the cord like anterior

longitudinal ligament.

(3) The posterior atlanto-occipital membrane extends

from the posterior margin of the foramen magnum

above, to the upper border of the posterior arch of

the atlas below. Inferolaterally it has a free margin

which arches over the vertebral artery and the first

cervical nerve. Laterally it is continuous with the

posterior part of the capsular ligament.

MOVEMENTS:

Since these are ellipsoid joints, they permit movements around

axis. Flexion and extension occur around a transverse axis. Slight

lateral flexion is permitted around on anteroposterior axis.

(1) Flexion is brought about by the longus capitis and the

rectus capitis anterior.

(2) Extension is done by the rectus capitis posterior major and

minor, the oblique’s capitis superior, the semispinalis capitis,

the splenius capitis and the upper part of the trapezius.

(3) Lateral flexion is produced by the rectus capitis

lateralis, the semispinalis capitis, the splenius capitis, the

sternomastoid and the trapezius.

ATLANTO-AXIAL JOINTS

These joints are comprised:

(1) A pair of lateral atlanto-axial joints between the

inferior facets of the atlas and the superior facets of the

axis. These are plane joints.

(2) A median atlanto-axial joint between the dens

(odontoid process) and the anterior arch and transverse

process of the atlas. It is a pivot joint. The joint has two

separate synovial cavities, anterior and posterior.

LIGAMENTS:

(a) The lateral atlanto-axial joints are supported by a

capsular ligament all around, the lateral part of the

anterior longitudinal ligament and the ligamentum

flavor.

(b) The median atlanto-axial joint is strengthened by

the following-

(1) The anterior small part of the joint between the anterior arch

of the atlas and the dens is supported by a loose capsular

ligament.

(2) The posterior larger part of the joint between the dens and

the transverse ligament is often continuous with one of the

atlanto-occipital joints. Its main support is the transverse

ligament which forms a part of the cruciform ligament of the

atlas.

The transverse ligament is attached on each side to the medial

surface of the lateral mass of the atlas. In the median plane its

fibers are prolonged upwards to the basioccipital and downwards

to the body of the axis, thus forming the cruciform ligament of

the atlas vertebra. The transverse ligament embraces the narrow

neck of the dens and prevents its dislocation.

MOVEMENTS:

Movements at all three joints are rotatory and take place around

a vertical axis. The dens form a pivot around which the atlas

rotates. The movement is limited by the alar ligaments.

The rotatory movements are brought about by the obliques

capitis inferior, the rectus capitis posterior major and the splenius

capitis of one side, acting with the sternomastoid of the opposite

side.

ANATOMY OF THE SPINAL CORD

The spinal cord is the lower elongated, cylindrical part of the CNS.

It occupies the upper two thirds of the vertebral canal. It extends

from the level of the upper border of the atlas to the lower border

of vertebra L1, or the upper border of vertebra L2.

It is about 45cm long. The lower is conical and is called the conus

medullaris. The apex of the conus is continued down as the filum

terminale.

Along its length, the cord presents two thickenings, the cervical

and lumbar enlargements, which give rise to large nerves for the

limbs. The spinal cord gives off 31 pairs of spinal nerves.

INTERNAL STRUCTURE:

When seen in transverse section the gray matter of the spinal

cord forms an H shaped mass. In each half of the cord the gray

matter is divisible into anterior gray column and posterior gray

column. In some part of the spinal cord a small lateral gray

column is also present. The gray matter of the right and left

halves of the spinal cord is connected across the midline by the

gray commisure which is traversed by the central canal.

The white matter of the spinal cord is divisible into right and left

halves in front by a deep anterior median fissure; and behind by

the posterior median septum. In each half the white matter is

divided into (1) the posterior white column or posterior funiculus;

(2) the lateral white column or lateral funiculus and (3) the

anterior white column or anterior funiculus. The white matter of

the right and left sides is continuous across the midline through

the white commisure which lies anterior to the grey commisure.

The spinal cord gives attachment, on either side, to a series of

spinal nerves. Each spinal nerve arises by two roots, (1) anterior

or ventral; (2) posterior or dorsal. Each root is made up of a

number of rootlets. The length of the spinal cord giving origin to

the rootlets for one spinal nerve constitutes one spinal segment.

As the cord is much shorter than the length of the vertebral

column the spinal segments do not lie opposite the corresponding

vertebra. In estimating the position of a spinal segment in

relation to the surface of the body it is important to remember

that a vertebral spine is always lower than the corresponding

spinal segment. As a rough estimate it may be stated that in the

cervical region there is a difference of one segment; in the upper

thoracic region there is a difference of two segments; and in the

lower thoracic region there is a difference of three segments.

TRACTS OF THE SPINAL CORD

A collection of nerve fibres that connects two masses of grey

matter within the central nervous system is called a tract. Tracts

may be ascending or descending. They are usually named after

the masses of grey matter connected by them.

(A) DESCENDING TRACTS

(1) The corticospinal tract

(2) The rubrospinal tract

(3) The olivospinal tract

(4) The vestibulospinal tract

(5) The tectospinal tract

(6) The lateral and medial reticulospinal tracts

(7) Medial longitudinal bundle

(B) ASCENDING TRACTS

(1) Tracts in the posterior funiculus

Fasciculus gracilis

Fasciculus cuneatus

(2) Tracts in the lateral funiculus

Lateral spinothalamic tract

Anterior and posterior spinocerebellar tracts

Spino-olivery tract

Spinotectal tract

(3) Tracts in the anterior funiculus

Anterior spinothalamic tract

ANATOMY OF SPINAL NERVES

Spinal nerves connect the CNS to receptors, muscles and glands

and are part of the peripheral nervous system. The 31 pairs of

spinal nerves are named and numbered according to the region

and the level of the spinal cord from which they emerge.

The first cervical pair emerges between the atlas and the occipital

bone. All other spinal nerves emerge from the vertebral column

through the intervertebral foramina between adjoining vertebras.

There are 8 pairs of cervical nerves, 12 pairs of thoracic, 5 pairs

of lumbar, 5 pairs of sacral and 1 pair of coccygeal nerves.

COMPOSITION AND COVERINGS

A typical spinal nerve has two separate points of attachments to

the cord: a posterior root and an anterior root. The posterior and

anterior roots unite to form a spinal nerve at the intervertebral

foramen. Since the posterior root contains sensory fibres and the

anterior root contains motor fibres, a spinal nerve is a mixed

nerve, at least at its origin. The posterior root contains a ganglion

in which cell bodies of sensory neurons are located.

The individual fibres whether myelinated or unmyelinated are

wrapped in a connective tissue called the endoneurium. Groups of

fibres with their fascicles and each bundle are wrapped in

connective tissue called the perineurium. The outermost covering

around the entire nerve is the epineurium. The duramater of

spinal meninges fuses with the epineurium as the nerve exits

through the intervertebral foramen.

PLEXUSES

The ventral rami of spinal nerves, except for thoracic nerves T2-

T12, do not go directly to the body structures they supply.

Instead, they form networks on both left and right sides of the

body by joining with varying numbers of fibres from ventral rami

of adjacent nerves. Such a network is called a plexus.

The principal plexuses are the cervical plexus, brachial plexus,

lumbar plexus and sacral plexus. Emerging from the plexuses are

the nerves bearing names that are often descriptive of the

general regions they serve or the course they take. Each of the

nerves in turn may have several branches named for the specific

structures they innervate.

CERVICAL PLEXUS

The cervical plexus is formed by the ventral rami of the first four

cervical nerves (C1-C4) with contributions from C5. There is one

on each side of the neck along side the first four cervical

vertebras.

The cervical plexus supplies the skin and muscles of the head, neck

and upper part of the shoulders. Branches of the cervical plexus also

connect with cranial nerves X1 and X12. The phrenic nerves arise

from the cervical plexuses and supply motor fibres to the

diaphragm.

CERVICAL PLEXUS

NERVE ORIGIN DISTRIBUTION

Superficial or sensory branches

Lesser occipital C2 Skin of scalp behind and above ear

Greater auricular C2-C3 Skin in front, below and above ear and over parotid gland

Transverse cervical C2-C3 Skin over anterior aspect of neck

Supraclavicular C3-C4 Skin over upper portion of chest and shoulder

CERVICAL PLEXUS

Deep or largely motor branches

Ansa cervicalis

-superior root

-inferior root

C1

C2-C3

- Infrahyoid and

geniohyoid muscles

of neck

- infrahyoid muscles

of neck

Phrenic C3-C5 Diaphragm between thorax and abdomen

Segmental branches C1-C5 Deep muscles of neck

BRACHIAL PLEXUS

The vertical rami of spinal nerves C5-C8 and T1 form the brachial

plexus. The brachial plexus extends downward and laterally on

either side of the last four cervical and first thoracic vertebra. It

passes over the first rib behind the clavicle and then enters the

axilla.

BRACHIAL PLEXUS

NERVE ORIGIN DISTRIBUTION

Dorsal scapular C5 Levator scapulae,

rhomboideus major amd

minor muscles

Long thoracic C5-C7 Serratus anterior

Nerve to

subclavius

C5-C6 Subclavius muscles

Suprascapular C5-C6 Supraspinatus and

infraspinatus muscles

Musculocutaneous C5-C7 Corachobrachialis, biceps

brachii and brachialis

muscle

Median(lateral

head)

C5-C7 Flexors of forearm, skin of

lateral 2/3 of palm and

fingers

Lateral pectoral C5-C7 Pectoralis major muscle

Upper

subscapular

C5-C6 Subscapularis muscle

Thoracodorsal C6-C8 Latissimus dorsi muscle

Lower

subscapular

C5-C6 Subscapularis and teres

major muscles

Axillary C5-C6 Deltoid and teres minor,

skin over deltoid and upper

posterior aspect of arm

Radial C5-C8 and Extensors of arm and

T1 forearm, lateral 2/3 of

dorsum of hand

Medial pectoral C8-T1 Pectoralis major and minor

muscles

Medialbrachial

cutaneous

C8-T1 Medial and posterior aspect

of lower third of arm

Medialantebrachial

cutaneous

C8-T1 Medial and posterior aspect

of forearm

Median C5-C8and

T1

Flexors of forearm, skin of

lateral 2/3 of palm of hand

and fingers

Ulnar C8-T1 Flexors carpi ulnaris, skin

of medial side of hand,

little finger and medial half

of little finger

PHYSIOLOGY OF PAIN, TOUCH, THERMAL AND

OTHER SENSES

THE PATHOPHYSIOLOGY OF PAIN

Pain is produced when a nociceptive (injurious) stimulus is received

(the nociceptivr stimulus either causes actual damage or is a

potentially damaging agent of the tissues). The injurious agent may

be (1) Mechanical (cuts, blows etc), (2) Chemical (acids etc.),(3)

Thermal(burn) or (4) Disease. The term ‘tenderness’ means, pain

elicited by pressing the part.

Pain is unpleasant sensation no doubt, but on the whole it is usually

beneficial to the man. Pain makes us conscious of the presence of

the injurious agent and that is why we seek removal of the injurious

agent by appropriate measures. However, in some cases, the

presence of pain may be counter productive to the interest of

patient. The classical example is pain in incurable cases of cancers.

RECEPTORS AND STIMULUS

Bare nerve terminals serve as pain receptor. However, other

cutaneous receptors, when stimulated excessively, may cause pain.

In the damaged tissues, particularly in the skin, some algogenic

substances are released. These algogenic substances come in

contact with the pain receptors pain is produced. Possibly these

substances are-(1)bradykinin (2) serotoninm (3)K+ ions(4) AMP (5)

acetylcholine. Prostaglandins are not very algogenic but they

potentiate the algogenic power by serotonin and bradykinin.

PROPERTIES OF PAIN

(1)Threshold and intensity

If intensity of the stimulus is below the threshold, pain is not felt. As

the intensity increases more and more, pain is felt more and more

and the pain sensation spreads. However if the mind is distracted,

the threshold of pain increases. Severe excitement and emotion can

altogether abolish even a severe pain.

(2)Adaptation

Pain receptors show no adaptation and so the pain continues as long

as the receptors continue to be stimulated.

(3)Localisation of pain

Pain sensation is somewhat poorly localized. However, superficial

pain is comparatively better localized than the deep pain. Visceral

pain is usually reffered (ie felt at a place which is other than the

area overlying the viscus).

(4)Influence of the rate of damage on the intensity of pain

If the rate of injury is high, intensity of pain is also high and vice

versa. Therefore, a very slowly growing tissue damaging agent (e.g.

Cancer at early stage), May not produce any pain at all.

(5) First (past) and second (slow) pain

After receiving a nociceptive stimulus, two types of nerve fibres are

stimulated. The AS fibres are somewhat thick and finely myelinated

with a faster rate of conduction but C fibres are very thin and

nonmyelinated with much slower rate of conduction. C type of fibres

however outnumber the AS fibres.

When an injury is received both or any one of the groups of fibres

may be stimulated (depending on the nature of stimulation), but

sensation due to the stimulation of AS fibres are felt earlier whereas

that due to C fibres are felt after a long time(because of the

slowness of conducting of C fibres). They are called first or fast and

second or slow pain respectively. Usually, the pain due to C fibre

stimulation is particularly unpleasant and outlasts the period of

stimulation. Second pain is also spoken of as pathological pain.

Besides the fast pain is better localized while the slow pain is not.

Neuro transmitter and path of pain

(1) The transmitter

The AS and the C terminate on the dorsal horn of the spinal cord.

The first neuron ends here. Almost certainly the synaptic transmitter

is substance P, secreted by the terminals of the C as well as fibres.

(2) The path

The tip of the dorsal horn is called ‘substantia gelatinosa rolandi’. AS

fibres and C fibres terminate at SGR. From the SGR, the next order

neurons arise and cross to the opposite side and form the

‘spinothalamic tract’. The STT reaches ultimately the thalamus.

From the thalamus, the next order neuron arises to end is the

sensory cortex in the parietal lobe.

Some descending fibres from the brain terminate on the SGR. They

constitute a tract that causes inhibition of pain.

In the above description of the path of pain, it was assumed, that

the pain arose from a somatic structure. Under some condition, pain

can also arise from the viscera. Abdominal visceral pain is carried by

afferent sympathetic fibres. However cortical representation of

visceral pain sensation is rather poor.

Pelvic splanchnic and vagus are also known to carry visceral pain

sensations. Thus pelvic visceral pain is also carried by pelvic

splanchnics.

Touch sensation

Touch sensation may be fine or crude. Touch receptors are found in

the skin and include meissner’s corpuscle, pacinian corpuscle and

ruffini’s organ.

Some parts of the body are very sensitive to touch, whereas the

skin of the back is relatively insensitive. Touch receptors adapt

quickly. The sense of vibration, pressure and two point

discrimination are all basically tactile sensations.

Thermal sensation

Cold and warm receptors are nerve endings which are simply called

cold receptors and warmth receptors respectively. Cold receptors

are more numerous than the warmth receptors. ‘cold spots’ in the

skin are distinct from ‘warmth spots’.

CERVICAL SPONDYLOSIS

DIFFERENTIAL DIAGNOSIS OF CERVICAL SPONDYLOSIS

The diseases to be considered in differential diagnosis of cervical

spondylosis are:

(A) Other causes of pain in the neck

(1) Trauma to the cervical spine

Trauma to the cervical spine (fractures, subluxation) places the

spinal cord at risk for compression. Motor vehicle accidents, violent

crimes, or falls account for 87% of spinal cord injuries, which can

have devastating consequences.

Emergency immobilization of the neck prior to complete assessment

is mandatory to minimize further spinal cord injury from movement

of unstable cervical spine segment.

(2) Cervical disc disease

Herniation of a lower cervical disc is a common cause of neck,

shoulder, and arm or hand pain. Neck pain (worse with movement),

stiffness and limited range of neck motion are common.

With nerve root compression pain may radiate into a shoulder

or arm. Extension and lateral rotation of the neck narrows the

intervertebral foramen and may reproduce radicular symptoms.

(3) Rheumatoid arthritis of cervical apophysial joints

RA of cervical apophysial joints results in neck pain, stiffness

and limitation of motion. In typical cases with symmetric

inflammatory polyarthritis the diagnosis of RA is straight forward.

In advanced RA synovitis of the atlantoaxial joint (C1-C2) may

damage the transverse ligament of the atlas, producing forward

displacement of the atlas on the axis (atlanto-axial subluxation).

(4) Injury to brachial plexus and nerves

Pain from injury to the brachial plexus or arm peripheral

nerves can occasionally be confused with pain of cervical spine

origin.

Neoplastic infiltration of the lower trunk of the brachial plexus may

produce shoulder pain radiating down arm. Post radiation fibrosis on

a pancoast tumour of lung may produce similar findings.

(B) Other causes of shoulder pain

Pain in the shoulder region can be difficult to separate clearly

from neck pain. The symptoms and signs of radiculopathy are

absent, then the differential diagnosis includes mechanical shoulder

pain (tendonitis, bursitis, rotator cuff tear, dislocation, adhesive

capsulitis and cuff impingment under the acromian) and reffered

pain (subdiaphragmatic irritation, angina, pancoast tumour).

Mechanical pain is often worse at night, associated with local

shoulder tenderness and aggravated by abduction, internal rotation,

or extension of the arm. The pain of shoulder disease may at times

radiate into the arm or hand but the sensory, motor and reflex

changes that indicate disease of the nerve roots, plexus or

peripheral nerve is absent.

MANAGEMENT

The symptoms of cervical spondylosis undergo spontaneous

remissions and exacerbations. The treatment is aimed at assisting

the natural resolution of the temporarily inflamed soft tissue.

(A) During the period of remission the prevention of

any further attacks is of utmost importance, and is done by advising

the patient regarding the following-

(1) Proper neck posture: The patient must avoid

situations where he has to keep his neck in one position for

a long time.

(2) Only a thin pillow should be used at night

(3) Neck muscle exercises. These help in improving the neck

posture.

(B) During an episode of acute exacerbation the following treatment

is required.

(1) Hot fomentation

(2) Rest to the neck in a cervical collar

(3) Traction to the neck if there is stiffness.

APPROACH TO THE PATIENT WITH SPINE

DISORDER

A patient with spine disorder presents either with pain usually in the

cervical or lumbosacral region; or with a deformity. The deformity

may be a kyphosis or scoliosis. Sometimes, there may be no or

minimal symptoms in the back, but are primarily in the limbs. Upper

limb pain in cervical disorders and lower limb pain in the lower limb

disorders.

At times the presenting symptom of a patient with spine disorder is

neurological deficit- quadriplegia, paraplegia or paraesthesia and

weakness pertaining to one or more nerve roots

History taking

The following are the common presenting complaints:

(1) Pain in the neck or back.

(2)Radiating pain in the upper limbs, girdle-pain along the

trunk, or sciatic pain along the back or front of leg

(3)Paraesthesia and weakness is a part of the limb due to

involvement of one or more nerve roots.

(4)More extensive weakness of limbs, eg: paraplegia or

quadriplegia.

History of presenting illness

(1) Pain

Pain is a common symptom. It is mostly non-specific but the

following are the some characteristic pains indicating a specific

diagnosis.

(a) Sharp shooting pain down the limb, which is aggravated by

coughing or on minimal movements indicates a disc prolapse.

(b) Dull boring pain which increases on exertion, and gets

relieved on rest is due to osteoarthritis.

(c) Pain in a young male, associated with stiffness, more early

in the morning, which wears off as the person gets involved in daily

chores, would be seronegative spond-arthritis.

(d) Backache associated with the pain and numbness, radiating

down the leg, especially on exertion, and gets relieved on rest is

indicative of spinal canal stenosis. Such a symptom is called

neurological claudication.

(e) Back pain in the dorso-lumbar region in the young may be

due to traumatic or infective pathology.

(2) Neurological symptoms

Complaints such as weakness, numbness and paraesthesias are

often associated with spinal disorders. Symptoms localized to one

limb usually indicate disc pathology.

Bilateral lower limb weakness and loss of sensation occurs usually in

dorsal and dorso-lumbar spine diseases. A cauda-equina syndrome

presentation occurs in lumbar spine diseases. Neurological

symptoms in TB spine and in tumours are gradual in onset; in disc

prolapse these are rather sudden.

EXAMINATION OF THE PATIENT

(1) Exposure- A proper exposure of the whole spine is crucial. A

female patient should be asked to change and wear a gown open

from the back. A nurse or female attendant should be present when

examining a female patient.

(2) Position- A patient with cervical spine disease is examined with

the patient sitting on a stool so that the examiner can observe from

front, side or back. A patient with lumbar spine or dorso-lumbar

spine disease is examined first standing, then lying supine and lying

prone.

The following points are noted:

(a) Gait: Observe the gait as the patient walks into the room.

A side lurching gait may suggest a scoliosis. A patient with painful

condition of the spine walks rather continuously; walking with short

steps and a stiff spine. A patient with acute disc prolapse has a

forward atop and sideways tilt of the torso on the oelvis.

(b) Deformity: Normally, the neck has lordosis; the dorsal

spine is kyphotic and lumbar spine lordotic. The nape of the neck is

in a straight line above the natal cleft. The position of the shoulder,

scapular blades, lumbar hollows and iliac wings is symmetrical. Any

deviation could be due to disease.

A diffuse kyphosis occurs in ankylosing spondylosis, schuermann’s

disease, osteoporosis etc. A localized kyphosis may be very sharp

due to collapse of one vertebra or localized to collapse of 2-3

vertebra.

Loss of lumbar and cervical lordosis occurs in painful conditions of

that part of the spine. Scoliosis may be obvious, or may be detected

on carefully comparing the symmetry of the spine as discussed

above. A transverse deep furrow, more like a step, may be seen in

the lumbosacral region in the spondylolisthesis.

Swelling in the paravertebral region or a little away could be due to

a cold abscess; prominence of one spinous process occurs in

traumatic spine. Prominence of more than two spinous processes

occurs most commonly in Pott’s spine.

Palpation

The following points are noted:

(1) Tenderness: Ask the patient to the point to the site of pain. A

general localization of the site of disease can be made by gently

hitting the spine from top to bottom with a fist. More specific

localization is made by pressing the spinous process with the

thumb.

(2) Movements: The following movements of the spine are noted;

(a) Flexion

The patient is asked to bend forward and touch his feet. While

he does so, the examiner feels the movement between the spinous

processes away from one another. Also, one should look for spasm

of the erector spinae muscles on both sides of the spine when

flexion is being tested.

(b) Side flexion

The patient is asked to bend sideways and any limitation is

noted.

(c) Rotations

The patient is asked to sit on a stool and side rotations are

examined.

Neurological testing

A complete neurological examination of the limb, especially if there

are symptoms such as radiating pain, paraesthesia or weakness is

necessary. This consists of the following:

(1) Straight leg raising test

This test indicates nerve root compression. With the patient lying on

a couch, his affected leg is lifted gradually with the knee straight. As

this is done, the patient complains of pain or stretching at the back

of the thigh or in the calf. The angle at which this occurs is noted. A

positive SLRT at 40 degrees or less is suggestive of root

compression. This leg is now lowered a little till the stretching

becomes less. At this angle if the ankle is passively dorsiflexed, the

pain at the back of thigh or in the calf will again be felt. This is

called reinforcement positive. Sometimes, a SLRT performed on the

affected side, may give rise to pain on the affected side. This is

termed a contra lateral positive SLRT and is a very specific sign of

root compression, possibly by a disc prolapse.

(2) Lasegue test

This is a modification of SLRT where first the hip is lifted to 90

degrees with the knee bent. The knee is then gradually extended by

the examiner. If nerve stretch is present, it will not be possible to

do so and the patient will experience pain in the back of the thigh or

leg.

(3) Motor power

These are examined in different muscle groups of the limb

especially that of EHL, ankle dorsiflexor is a case of disc prolapse.

(4) Sensory loss

These are examined dermatome wise, especially in L4,L5, S1

dermatomes.

(5) Reflexes

The deep and superficial reflexes and Babinski’s reflex are

examined.

General examination

The following examination should be done in a case with spine

disease.

(1) Look for cold abscesses away from the site of tuberculosis

of the spine.

(2) Chest should be examined to look for a tubercular focus

there, or to rule out an old chest disease.

(3) Examination of the breast, kidney, prostate, thyroid and

abdomen is necessary if a secondary is being suspected in the

spine.

MATERIAL AND METHODS

INVESTIGATIONS

Progressive neck pain is a key indication of cervical spondylosis. It

may be the only symptom in many cases. Examination often shows

limited ability to flex the head to the side (bend head toward

shoulder) and limited ability to rotate the head.

Weakness or sensation loss indicates damage to specific nerve roots

or to the spinal cord. Reflexes are often reduced.

(1) X-ray of cervical spine (AP and lateral) is sufficient in

most cases. The following radiological features may be present:

(a) Narrowing of the intervertebral disc spaces (most

commonly between C5-C6).

(b) Osteophytes at the vertebral margins, anteriorly and

posteriorly.

(c) Narrowing of the intervertebral foramen in cases

presenting with radicular symptoms may be best seen on oblique

views.

(2) A CT scan or spine MRI confirms diagnosis.

(3) A myelogram (x-ray or ct scan after injection of dye into

the spinal column) may be recommended to clearly identified the

extent of injury.

(4) An EMG may also be recommended.

(5) An X-ray of the lower (lumber) spine may reveal

degenerative changes in this region.

REVIEW OF HOMOEOPATHIC MEDICAL LITERATURE

MIASMATIC EVOLUTION

Miasm is an invisible, dynamic principle, which permeates into the

system of a living creature, creating a groove or stigma in the

constitution, which can only be eradicated by a suitable anti-

miasmatic treatment. If effective anti-miasmatic treatment does

not take place then the miasm will persist throughout the life of

the person and will be transmitted to the next generation.

Miasmatic dissection and incorporation of the same in each case

will help (a)to open up a case, where there is a scarcity of

symptoms due to various physical or emotional suppressions.

(b)to be more confident in prescribing by including the surface

miasm in the consideration of the totality, as miasm constitutes a

major part of totality(c)to evaluate the necessity of change of

plan of treatment (d) to evaluate the homoeopathic prognosis of

the case, as removal of layers of suppression manifest as clarity

of symptoms and can be accompanied by a quantum jump in the

sense of well being (e) anti-miasmatic medicines help to clean up

the presenting symptoms from its root of origin and clear up the

susceptibility to get infection and thereby strengthens the

constitution.

Basically psora is ‘hypo’ in expression which gives rise to hypo-

immunity, in turn resulting in hyper-susceptibility which manifests

as an exalted sensitivity to the external environment and allergens,

itching, irritation and burning lead towards congestion and

inflammation with only functional changes. Sycosis produces in

coordination everywhere resulting in overproduction, growth and

infiltration in the form of warts, condylomata, tumours, fibrous

tissues etc. Syphilis produces destructive disorder everywhere which

manifests as perversion, suppuration, ulceration and fissures. The

tubercular miasm produces changing symptomatology, confusing

vague symptomatology and conditions which are variable and

contradictory.

MANAGEMENT &

HOMOEOPATHIC TREATMENT

HOMOEOPATHIC APPROACH

Homoeopathy is the fingerpost on the crossroads of healing which

directs the way to safest and permanent cure. It is a very effective

and easy way to attain cure. Homoeopathic treatment can reward or

effective cure in cases of initial period of disease. In chronic cases or

late start of treatment, Homoeopathy can relieve congestion of

spine and compression of nerves, if there is no fixation of bones.

The treatment cannot arrest the progressive degenerative changes.

In case of a badly deformed spine, it can only help with temporarily

management of pain. The results of Homoeopathy in managing

cervical spondylosis will be marvelous and dramatic compared to

other systems of medicine or surgical intervention.

One thing everyone should accept is that we cannot do against

nature i.e. if it is due to ageing process, we have to accept it. But

surely, we can live better without any complaint or pain with proper

posture and homoeopathic medicine likewise, structural damage in

advanced cases cannot be cured completely but we can manage the

condition without pain. We can aim for near normal in all cases. If

we mask the pain with external application or pain killers, without

treating the actual condition then it will lead to complications due to

use of the neck in spite of pain or complaints which have been

masked.

Homoeopathic medicines commonly used in case of cervical

spondylosis:

(A) DURING ACUTE EXACERBATIONS

1) Belladonna – Stiff neck. Pain in nape, as if it would break.

Pressure on dorsal region most painful. Vertigo, with falling to left

side or backwards. Sensitive to least contact. Much throbbing and

heat. Pain worse light, noise, jar, lying down and in afternoon;

better by pressure and semi erect posture it is always associated

with hot, red skin, flushed face, glaring eyes, throbbing carotids,

excited mental state, hyperesthesia of all senses, delirium, restless

sleep, convulsive movements, dryness of mouth and throat with

aversion to water, neurological pains that come and go suddenly. No

thirst, anxiety or fear. For violence of attack and suddenness of

onset.

2) Arnica – Great fear of being touched or approached. Pain in

neck and limbs, as if bruised or beaten. Sprained and dislocated

feeling. Soreness after overexertion. Everything on which he lies

seems too hard. Vertigo; objects whirl about especially suited to

cases when an injury, however remote, seems to have caused the

present trouble. After traumatic injuries, overuse of any organ,

strains. A muscular tonic, worse least touch, rest, damp cold,

better, lying down or with head low.

3) Bryonia –Painful stiffness in nape of neck. Stitches and stiffness

in small of back from sudden change of weather. Joints red, swollen,

hot with stitches and tearing; worse on least exertion every spot is

painful on pressure. Vertigo, nausea faintness on rising, confusion.

Headache seated in occiput, worse on motion, even of eyeballs. The

general character of the pain produced is stitching, tearing; worse

by motion better rest.

4) Cimcifuga Racemosa – Stiffness and contraction in neck and

back. Spine is very sensitive, especially upper part. Rheumatic pains

in muscles of back and neck. Crick in back. Aching in limbs and

muscular soreness. Uneasy restless feeling in limbs. Heaviness in

lower extremities. Heavy aching with tensive pain. Especially useful

in rheumatic nervous subject with ovarian irritation, uterine cramps

and heavy limbs. Its muscular and crampy pains occurring in nearly

every part of the body are characteristic. Agitation and pain indicate

it.

5) Chelidonium majus –Pain in nape, stiff neck, head drawn to

left. Fixed pain under inner and lower angle of right scapula. Pain at

lower angle of left scapula. Pain in arm, shoulders, hands tips of

fingers. Icy coldness of tips of fingers. Icy coldness of occiput from

nape of neck; feels heavy as lead. Vertigo associated with hepatic

disturbance. The great general lethargy and indisposition to make

any effort is also marked ailments brought on or renewed by change

of weather. Worse, right side, motion, touch, very early in morning.

Better from pressure.

6) Colchicum- Pain in occiput and nape of neck, worse afternoon

and evening. Backache better rest and pressure. Sharp pain down

left arm. Tearing in limbs during warm weather, stinging during

cold. Pins and needles in hands and wrists, fingertips numb, pain in

front of thigh. Right plantar reflex abolished limbs lame, weak

tingling, worse in evening and warm weather. Joints stiff and

feverish shifting rheumatism pains worse at night. Affects markedly

the muscular tissues, periosteum and synovial membranes of joints.

The parts are red, hot and swollen.

7) Gelsemium- Pain in neck, especially upper sternocliedomastoid

muscles. Dull, heavy pain. Pain in muscles of back, hips and lower

extremities, mostly deep seated cramps in muscles of forearm.

Vertigo spreading from occiput. Heaviness of head; band feeling

around and occipital headache. Dull, heavy ache with heaviness of

eyes; bruised sensation; better compression and lying with head

high. Dizziness, drowsiness, dullness and trembling.

8) Kalmia latifolia- pain from neck down arm; in upper three

dorsal vertebrae extending to shoulder blade. Pain down neck, as if

it would break; is localized regions of spine; through shoulders.

Lumbar pains of nervous origin. Pain affects a large part of limb, or

several joints and pass through quickly. Weakness, numbness,

pricking and sense of coldness in limbs. Pain along ulnar nerve,

index finger. Tingling and numbness of left arm, neuralgia; pains

shoot downwards, with numbness.

9) Lachnantes- pain in nape, as if dislocated, stiffness of neck.

Rheumatism of the neck. Neck drawn over to one side. Chilliness

between the shoulder-blades; pain and stiffness in back produces a

desire to talk, a flow of language and the courage to make a

speech. Right sided pain in head, extending down to jaw; head feels

elongated; worse least noise. Sleepless. Burning in palms and soles.

10) Nux vomica- pain and stiffness in cervical region. Burning in

spine; worse 3 to 4 am. Cervico-brachial neuralgia; worse touch.

Must sit up in orde to turn in bed. Bruised pain below scapulae.

Sitting is painful. Arms and hands go to sleep. Headache in occiput

with vertigo; brain feels turning in a circle, oversensitiveness.

Patient is thin, spare, quick, active, nervous and irritable, leading a

sedentary life, found in prolonged office work and overstudy. Worse

cold. Better in evening, while at rest, in damp wet weather, strong

pressure.

11) Rhus toxicodendron- Stiffness of the nape of neck. Pain

between shoulders on swallowing tearing pains in tendons,

ligaments and fasciae. Rheumatic pains spread over a large surface

at nape of neck, loins and extremities; better motion. The cold fresh

air is not tolerated. Pain along ulnar nerve. Crawling sensation in

tips of fingers. Headache in occiput, painful to touch. Heavy head.

Vertigo when rising. Motion always ‘limbers up’ the patient and

hence feels better for a time from a change of position. Ailments

from strains, over lifting, getting wet while perspiring. Worse, during

sleep, cold wet weather and after rain, rest, lying on back or right

side. Better, warm dry weather, motion, rubbing, warm application,

from stretching out limbs.

(B) DURING THE PERIOD OF REMISSION.

(1) Arsenicum album- Stiffness and pain in cervical region.

Drawing in of shoulders. Pain and burning in back. Heaviness and

uneasiness in extremities. Burning pains relieved by warmth.

Headaches relieved by cold other symptoms worse. Periodical

burning pains with restlessness. Its general symptoms often alone

lead to its successful application. Among these the all prevailing

debility, exhaustion and restlessness, with nightly aggravation are

most important. Great exhaustion often the slightest exertion. Fear

fright and worry. Degenerative changes. Worse, wet weather, after

midnight, from cold drinks or food, right side. Better from heat,

from head elevated, warm drinks.

(2) Causticum- dull pain in nape of neck. Stiffness between

shoulders. Dull tearing pain in hands and arms. Heaviness and

weakness. Numbness; loss of sensation in hands. Rheumatic tearing

in limbs; better by warmth; especially from heat of bed. Manifests

its action mainly in chronic rheumatic, arthritic and paralytic

affections, indicated by tearing, drawing pains in muscular and

fibrous tissues with deformities about joints; progressive loss of

muscular strength, tendinous contractures. The skin of a person is

of dirty white, sallow with warts, especially on the face. Emaciation

due to disease, worry etc and of long standing. Burning rawness and

soreness are characteristic.

(3) Conium- pain between shoulders. Ill effects of bruises and

shocks to spine. Extremities heavy, weary, paralysed; fingers and

toes numb. Muscle weakness, especially of lower limbs. Perspiration

of hands. Putting feet on chair relieves pain. Vertigo, when lying

down and when turning over in bed, when turning head sidewise or

turning eyes; worse shaking head, slight noise or conversation of

others, especially towards the left. Dull occipital pain on rising in

morning. Troubles at change of life. Old maids and bachelors.

Weakness of body and mind, trembling and palpitation. Worse

before and during menses, from taking cold, bodily or mental

exertion, celibacy. Better while fasting, in the dark, from letting

limbs hang down, motion and pressure.

(4) Ferrum metalicum- Rheumatic pain in left arm and

shoulder. Lumbago; better, slow walking. Pain in hip joint, tibia,

soles and heel. Pain in back of head, with roaring in neck. Vertigo in

seeing flowing water. Best adapted to young, weak persons,

anaemic and chlorotic, with pseudo-plethora who flush easily; cold

extremities; over sensitiveness worse after any effort. Weakness

from mere speaking or walking through looking strong pallor of skin,

mucous membranes, face alternating with flushes. Better walking,

slowly about. Better, after rising. Worse while sweating; while

sitting still. After cold washing and overheating. Midnight

aggravation.

(5) Graphites- Pain in nape of neck shoulders and back and

limbs. Spinal pains. Left hand numb; arms feel asleep. Patients, who

are rather stout, of fair complexion with tendency to skin affections

and constipation, fat chilly and costive, with delayed menstrual

history. Take cold easily. Has a particular tendency to develop the

skin phase of internal disorders. Anemia with redness of face.

Tendency to obesity. Timid, indecisive, music makes her weep,

worse warmth, at night, during and after menstruation. Better, in

the dark, from wrapping up.

(6) Lac caninum- rheumatic pains in the extremities and back,

from one side to the other. Pain in arms to fingers. Pain and

stiffness in neck. Burning in palms and soles. Sensation of walking

or floating in the air. Headache. First one side, then the other.

Occipital pain with shooting extending to forehead. The keynote

symptom is erratic pains, alternating sides. Feels as if walking on air

or of not touching the bed when lying down great weakness and

prostration. Despondent, visions of snakes. Dreams of snakes.

Worse, morning of one day and in the evening of next. Better, cold,

cold drinks.

(7) Lachesis- Pain in neck. Worse cervical region. Sensation of

threads stretched from back to arms, legs, eyes. Sensation of

tension in various parts. Cannot bear anything tight anywhere. Pain

through head on awakening. Pressure and burning on vertex with

headache, flickering, dim vision, very pale face. Vertigo relieved by

onset of discharge. Great loquacity. Jealous, suspicious. Worse after

sleep, left side, in the spring, warm bath, pressure or constriction,

hot drinks, closing eyes. Better appearance of discharges, warm

application.

(8) Lycopodium- Pain and stiffness in the neck. Burning

between scapulae as of hot coals. Numbness also, drawing and

tearing in limbs especially while at rest or at night. Heaviness of

arms; tearing of shoulder and elbow joints. Limbs go to sleep.

Shakes head without apparent cause. Tearing pain in occiput, better

fresh air. Vertigo in morning on rising. In nearly all cases where

Lycopodium is the remedy, some evidence of urinary or digestive

disturbances will be found. Melancholic, afraid to be alone. Loss of

self confidence. Apprehensive. Weak memory, confused thoughts,

worse right side, from right to left, from above downwards, 4-8 pm;

from heat or warm room. Warm applications except throat and

stomach which are better from warm drinks. Better by motion, after

midnight, from warm drink, on getting cold, from being uncovered.

(9) Medorrhinum- stiffness in neck region. Pain in back, with

burning heat. Burning of hands and feet. Restless, better clutching

hands. Legs heavy ache all night; cannot keep them still. Heels and

balls of feet tender. Head heavy and drawn backward. Burning pain

in brain, worse occiput. Headache from jarring of cars, exhaustion

or hardwork. Chronic ailments due to suppressed gonorrhea. Great

disturbance and irritability of nervous system. Pains intolerable,

tensive and nerves quiver and tingle. History of sycosis worse when

thinking of ailment, from day to sunset, heat. Better at seashore,

lying on stomach, damp weather.

(10) Pulsatilla- shooting pain in the nape of neck and back

between shoulders; in the sacrum after sitting. Pain in limbs,

shifting rapidly; tensive pain, letting up with a snap. Numbness

around elbow. Veins in forearm and hands swollen. Legs feel heavy

and weary. Vertigo, better in open air. Neuralgic pains, commencing

in night, temporal region with scalding lachrymation of affected

side. The disposition and mental state are chief guiding symptoms.

It is pre-eminently a female remedy, especially for mild, gentle,

yielding disposition. Worse from heat. Better, open air, cold

applications.

(11) Sulphur- Stiffness of nape. Drawing pains between

shoulders. Sensation as if vertebrae glided over each other.

Trembling of hands. Rheumatic pains in left shoulder. Burning in

soles and hands at night. Stoop shouldered. Constant heat on top of

head. Heaviness and fullness. Beating headache; worse stooping

and with vertigo. Standing is the worst position for sulphur patient.

Ebullitions of heat, dislike of water, dry and hard hair and skin, red

orifices, sinking feeling at stomach about 11 am and cat-nap sleep;

always indicate sulphur homoeopathically.

AUXILIARY TREATMENT

PHYSIOTHERAPY

The goal of physiotherapy treatment is to relieve pain, and

enhance movements of the neck.

Shortwave diathermy - A disc or heating pad is placed over the

back of the neck. The warmth obtained from the shortwave

diathermy current relaxes the muscle and the pain is relieved.

Cervical Traction - Traction is a mechanical device, which

supports the head and chin. It is used to relieve the nerve

compression by a bone.

Posture correction - Simple postural exercises can be taught to

correct the faulty position of the neck.

Motivation is given to maintain the erect posture:

Collars - Two types of collars can be prescribed:

1.Soft Collar - Soft collar is used during night times to prevent

awkward position of the neck during sleep.

2.Firm Collar - Firm collar steadies the neck and relieve pain,

especially during traveling or work. It is removed when the pain

subsides.

RELAXATION

Relaxation is essential part of treatment. Tension in neck and

shoulder muscle, pain, anxiety is all relieved by relaxation.

Relaxation can be done in two ways:

A) Physical Relaxation.

B) Mental Relaxation.

A) PHYSICAL RELAXATION:

The whole body is relaxed by free suitable and comfortable

positions, so that the muscles are freed from tension and the pain

is relieved. For e.g., position of relaxation - when you are lying

flat on your back.

1. One pillow under the head

2. One cushion for the shoulder and

3. One under knees.

The pillow should be firm and thin.

This position will allow relaxation for your body while lying down.

Relaxation while sitting.

1. The head, neck and shoulder are supported by high backed

chair, with a small pillow at lower back.

2. Feet supported on stool or low bench.

3. Arm, resting on arm of chair or pillow.

B) MENTAL RELAXATION

Positive thinking and using imagination is the way of relaxing

mentally. This type makes one feel better and breaks the pain

cycle. Muscle tension, anxiety, loss of sleep and pain are all

relieved by mental relaxation exercises like yoga.

LIFESTYLE MODIFICATIONS

Some modifications in life style will help in over coming problems

of cervical spondylosis. For example:-

1. Avoid any strain of neck and shoulder like reading and writing

for long hours.

2. Avoid the use of very soft cushion bed and avoid using a very

high pillow.

ERGONOMICS

Ergonomics concentrates on the architectural design of furnitures

like desk, chairs, tables etc. The design of the furniture should be

such that it should support the body structure without causing

any undue strain to the muscles of the back and neck.

DO'S AND DONT'S

If you are prone to cervical spondylosis, Avoid bad roads, if

travelling by two or four wheelers

1. Do not sit for prolonged period of time in stressful postures

2. Do use firm collars while traveling

3. Do not lift heavy weights on head or back

4. Do not turn from your body but turn your body moving your

feet first

5. Do turn to one side while getting up from lying down

6. Do the exercises prescribed regularly

7. Do use firm mattress, thin pillow or butterfly shaped pillow

8. Do not lie flat on your stomach.

CASE FORMATION

CASE NO…………. NAME OF PHYSICIAN……………….

REG NO…………… INTERN INCHARGE…………………..

PATIENT NAME……………………

AGE/SEX…………………..

OCCUPATION………………….

RELIGION…………………………….

MARITAL STATUS…………………..

ADDRESS………………………………

………………………………………….

DIAGNOSIS……………………………

CLINICAL HISTORY

CHIEF COMPLAINTS

HISTORY OF PRESENT ILLNESS

PAST ILLNESS

PERSONAL HISTORY

FAMILY HISTORY

FATHER

MOTHER

BROTHER

SISTER

W\H

OTHERS

SOCIAL STATUS

DITETIC HABITS

PHYSICAL EXAMINATION

GENERAL EXAMINATION

APPEARANCE BUILD

NUTRITIONAL STATUS HYDRATION

ANAEMIA OBVIOUS FOCAL SEPSIS

PULSE TEETH/GUMS

B.P. TONSIL

RESPIRATION EAR

TEMPERATURE SKIN

LOCAL EXAMINATION

SYSTEMIC EXAMINATION

• RESPIRATORY SYSTEM

• C.V.S.

• C.N.S.

GENERAL SYMPTOMS

PHYSICAL GENERALS

APP- D/A-

THIRST- SLEEP-

REACTION TO H/C- DREAMS-

STOOL- URINE-

MENSTRUATION-

MENTAL GENERALS

WILL

LOVE

HATE

FEAR

ANGER

TEMPER.

UNDERSTANDING

INTELLECT

THOUGHT

ILLUSION

HALLUCINATION

DELUSIONS

MEMORY

INVESTIGATION

ROUTINE INVESTIGATION

SPECIAL INVESTIGATION

EVALUATION OF SYMPTOMS & RUBRIC FORMATION

CONSULTATION OF REPERTORY

FINAL PRESCRIPTION

PROGRESS REPORT

DATE PROGRESS TREATMENT

GRAPHS

0

20

40

60

80

100

prevalance

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

age

prevalence of cervical spondylosis

PREVALENCE OF CERVICAL SPONDYLOSIS

SYNOPSIS OF CASES

CASE NO:-1

Mrs. Manju, 45/F/H, complaining of pain and stiffness in neck

since 2 years. Patient is chilly, sympathetic in nature and also

suffers from involuntary urination while coughing. Stiffness in

between shoulders & dull pain in nape of neck, especially

aggravated in clear fine weather & > in wet weather.

On the basis of general symptoms, constitutional medicine

Causticum 1M /3 doses was prescribed.

After 15 days, patient came back with great improvement. SL

was given & finally the patient was cured.

CASE NO: 2

Mr. J. P. singh, 51/M/H, complaining of pain and stiffness of neck

since 1 month with occipital headache and vertigo with dullness

and drowsiness. Excessive trembling & weakness of limbs. >

From bending forward & continued motion.

On the therapeutic basis Gelsemium 30/TDS was prescribed for 7

days.

Again on futher follow up SL was given after a marked

improvement, the case was cured.

CASE NO:3

Mrs. Sunita, 38/F/H, complaining of stiffness in neck since 1 year.

She also had joint pains which were constantly shifting position

from one side to another. < Heat and > cold; dreams of

snakes.Complaints are associated with burning in palms & soles

with history of recurrent tonsillitis.

On the basis of mental and physical general symptoms Lac Can

1M/ 3 doses and SL TDS for 7 days was prescribed.

On further follow up Lac Can 1M/3 dose was given & after that

patient was completely cured.

CASE NO: 4

Mrs. Kumud chauhan, 55/F/H, complaining of pain in right arm

and shoulder since 2 months; worse from motion and at night.

Also right sided headache since her menopause. Burning in palms

& soles, circumscribed red spots over malar bone.

On the basis of particular symptoms Sanguinaria 30 TDS for 7

days was prescribed.

On further follow up Sanguinaria 200 / 3 dose with SL was given

for 7 days and in next follow up patient came back with almost

complete cure.

CASE NO: 5

Mrs. Pooja kumari, 40/F/H, complaining of stiffness in neck since

3 years; contracted feeling in neck and rheumatic pains in

muscles of back & neck. Pain in lumbar & sacral region down

thighs, jerking of limbs & heaviness in lower limbs. Worse in cold

weather and during menses and better from warmth.

On the basis of particular symptoms and modalities, Cimcifuga 30

TDS for 7 days was prescribed.

On further follow up Cimcifuga 30/TDS for 7 days was repeated,

patient came back with much improvement. After that Cimcifuga

200/3 dose was given & patient was completely cured.

CASE NO: 6

Mr. Vikram, 28/M/H, complaining of stiffness of neck since 15

days; worse after prolonged office work also disordered stomach

and frequent and ineffectual urging for stool. Headache in occiput

region with vertigo as if turning in a circle, sitting is very painful.

On the therapeutic basis Nux vom 30 TDS for 7 days was

prescribed.

Patient came back with improvement, again Nux vom 30 was

repeated & he was completely cured.

CASE NO: 7

Mr. Ahmad, 32/M/M, complaining of soreness and stiffness of

neck and back since 2 months worse rainy weather and better

warmth, arm can not be moved because of pain also dread of

storm.

On the therapeutic basis Rhododendron 30 TDS for 7 days was

prescribed.

On further follow up Rhododendron 30/TDS for 7 days was

repeated, patient came back with much improvement. After that

Rhododendron 200/3 dose was given & patient was completely

cured.

CASE NO: 8

Mrs. Rukhsana, 35/F/M, complaining of pain and stiffness of neck

since 5 years, spine sensitive to touch, burning feet, desire for

oranges, weak memory and weeping tendency. Pain in back, legs

heavy; ache all night, even can not keep them still, very restless.

On the basis of general and particular symptoms Medorrhinum

1M/ 3doses and SL TDS for 7 days was prescribed.

Again on futher follow up SL was given after a marked

improvement, the case was cured.

CASE NO: 9

Mr. Rajaram, 62/M/H, complaining of pain in neck and left

shoulder since 6 months, worse after sleep, neck sensitive to

touch, hot patient, trembling of tongue and great loquacity. <

rising from sitting posture & must sit perfectly still. Sensation of

threads stretched from back to arms, legs etc.

On constitutional basis Lachesis 200/ 3 doses and SL TDS for 7

days was prescribed.

On further follow up Lachesis 200 / 3 dose with SL was given for

7 days and in next follow up patient came back with almost

complete cure.

CASE NO: 10

Mr. Janki prasad, 51/M/H, complaining of pain in neck and back

since 2 years, great sensitiveness to touch, had an injury 2 years

back since then had this complaint.Sore, lame ,bruised feeling in

back,everything seems too hard.

On therapeutic basis considering history of injury Arnica 200 TDS

for 7 days was prescribed.

On further follow up Arnica 1M/3 doses was given & after that

patient was completely cured.

CASE NO: 11

Mrs Farzana Khan, 47/F /M, complaining of stiffness of the nape

of neck. Pain between shoulders on swallowing tearing pains in

tendons, ligaments and fasciae. Rheumatic pains spread over a

large surface at nape of neck, loins and extremities; better

motion. The cold fresh air is not tolerated.

On therapeutic grounds Rhus Tox 200/3 dose for 7 days was

given.

On further follow up Lachesis 200 / 3 dose with SL was given for

7 days and in next follow up patient came back with almost

complete cure.

CASE NO: 12

Mr Vikas singh 68/M/H, complaining of stiff neck. Pain in nape, as

if it would break. Pressure on dorsal region most painful. Vertigo,

with falling to left side or backwards. Sensitive to least contact.

Much throbbing and heat. Pain worse light, noise, jar, lying down

and in afternoon; better by pressure.

On the therapeutic grounds Belladonna 30/TDS for 7 days was

given.

On further follow up Belladonna 30/TDS for 7 days was repeated,

patient came back with much improvement. After that Belladonna

200/3 dose was given & patient was completely cured.

CASE NO: 13

Mr Ashok Rawat 40/M/H, complaining of painful stiffness in nape

of neck. Stitches and stiffness in small of back from sudden

change of weather. Joints red, swollen, hot with stitches and

tearing; worse on least exertion every spot is painful on pressure.

On the therapeutic grounds Bryonia 30/TDS for 7 days was

prescribed.

Patient came back with improvement, again Bryonia 30 was

repeated & he was completely cured.

CASE NO: 14

Mrs Geeta, 38/F/H, complaining of stiffness in neck since 1 year.

She also had joint pains which were constantly shifting position

from one side to another. < Heat and > cold; dreams of

snakes.Complaints are associated with burning in palms & soles

with history of recurrent tonsillitis.

On the basis of mental and physical general symptoms Lac Can

1M/ 3 doses and SL TDS for 7 days was prescribed.

On further follow up Lac Can 1M/3 doses was given & after that

patient was completely cured.

CASE NO: 15

Mrs. Ranjana kumari, 40/F/H, complaining of stiffness in neck

since 3 years; contracted feeling in neck and rheumatic pains in

muscles of back & neck. Pain in lumbar & sacral region down

thighs, jerking of limbs & heaviness in lower limbs. worse in cold

weather and during menses and better from warmth.

On the basis of particular symptoms and modalities, Cimcifuga 30

TDS for 7 days was prescribed.

On further follow up Cimcifuga 30/TDS for 7 days was repeated,

patient came back with much improvement. After that Cimcifuga

200/3 dose was given & patient was completely cured.

CASE NO:-16

Mrs Ritu Gaur 51/F/H, complaining of pain in occiput and nape of

neck, worse afternoon and evening. Backache better rest and

pressure. Sharp pain down left arm. Tearing in limbs during warm

weather, stinging during cold. Pins and needles in hands and

wrists, fingertips numb, pain in front of thigh.

On therapeutic grounds Colchicum 30/TDS for 7 days was

prescribed.

On further follow up Colchicum 30/TDS for 7 days was repeated,

patient came back with much improvement. After that Colchicum

200/3 dose was given & patient was completely cured.

CASE NO: 17

Mrs. Rehana, 35/F/M, complaining of pain and stiffness of neck

since 5 years, spine sensitive to touch, burning feet, desire for

oranges, weak memory and weeping tendency. Pain in back, legs

heavy; ache all night, even can not keep them still, very restless.

On the basis of general and particular symptoms Medorrhinum

1M/ 3doses and SL TDS for 7 days was prescribed.

Again on futher follow up SL was given after a marked

improvement, the case was cured.

CASE NO: 18

Mrs. Malti shah, 45/F/H, complaining of pain and stiffness in neck

since 2 years. Patient is chilly, sympathetic in nature and also

suffers from involuntary urination while coughing. Stiffness in

between shoulders & dull pain in nape of neck, especially

aggravated in clear fine weather & > in wet weather.

On the basis of general symptoms, constitutional medicine

Causticum 1M /3 doses was prescribed.

After 15 days, patient came back with great improvement. SL

was given & finally the patient was cured.

CASE NO: 19

Mr Anand 28/M/H complaining of rheumatic pain in left arm and

shoulder. Lumbago; better, slow walking. Pain in hip joint, tibia,

soles and heel. Pain in back of head, with roaring in neck. Vertigo

in seeing flowing water.

On the therapeutic grounds Ferrum Met 200/3 dose with SL for 1

week was prescribed.

On further follow up Ferrum Met 200 / 3 dose with SL was given

for 7 days and in next follow up patient came back with almost

complete cure.

CASE NO: 20

Mr Archana Puran Singh 68/M/H, complaining of stiff neck. Pain in

nape, as if it would break. Pressure on dorsal region most painful.

Vertigo, with falling to left side or backwards. Sensitive to least

contact. Much throbbing and heat. Pain worse light, noise, jar,

lying down and in afternoon; better by pressure.

On the therapeutic grounds Belladonna 30/TDS for 7 days was

given.

On further follow up Belladonna 30/TDS for 7 days was repeated,

patient came back with much improvement. After that Belladonna

200/3 dose was given & patient was completely cured.

BIBLIOGRAPHY

1. Combined medical diagnostic treatment

1. Harrison’s practice of medicine

2. Robbins pathology

3. Anatomy of B D Chaurasia

4. Tortora’s anatomy and physiology

5. Guyton’s physiology

6. Kent’s materia medica

7. Boericke’s materia medica

8. Organon of medicine

9. Farrington’s materia medica

10. Dubey’s materia medica

11. Clarke’s materia medica

12. Phatak’s materia medica

13. Physiotherapy text book