Homoeopathic medicines in cervical spondylosis

Dr Sneha Jnanakshee H.R.

ABSTRACT:
Cervical spondylosis is a wear and tear degenerative disease of intervertebral disc and associated intervertebral joints mainly elderly people and which is caused by both physical and mental stress. It is defined as vertebral osteophytosis secondary to degenerative disc disease due to the osteophytic formations that occurred with nerve root compression and narrowing of spinal canal. It is the common disease that arises due to today’s stress life.

Nowadays, using computers and smart phones for a long time is one of the most common causes of cervical spondylitis in young people.

In conventional mode of treatment, since their aim is to relieve the pain, drugs has been given which shows adverse effects like insomnia, headache, giddiness, blurred vision, and loss of coordination. However surgical aid can be less effective and highly risky in elderly people.

However, it is not so in Homoeopathic system of medicine. In homoeopathy patient is considered as whole taking into consideration the role of the body mind and soul and treated accordingly.

Homoeopathy is highly recommended in chronic diseases like cervical spondylosis. An individualized approach in homoeopathy is highly effective in treating cervical spondylosis.Also, homoeopathy provides you effective relief in pain, stiffness of the cervical spine, reduce the inflammation of the disc and ligaments and improves the mobility of your neck and hands. If a patient has nerve root compression, the regular use of homeopathic medicines shows improvement in the relief from tingling sensation and numbness.

Homeopathic medicines are deep-acting and, hence, they control the further process of degeneration. Homoeopathy controls the progression of the disease and prevents further destruction of the disc and vertebrae to some extentGradually it can help to reduces the need for painkillers.

This article helps how to deal with the cervical spondylosis.

KEY WORDS: cervical spondylosis, Homeopathic medicines, Sector totality.

Causative factors/ Risk factors:
Age: An advancing age is a major factor in the development of cervical spondylitis. Cervical spondylitis is more commonly observed after the age of 40 years³.

Neck injuries: A history of a neck injury may increase the risk for the development of cervical spondylitis³.

Occupation: Work-related repetitive activities involving neck might put stress on the cervical spine. Individuals performing activities or professions, such as prolonged use of a computer, bike users, drivers, professional dancers or gymnasts, health care workers, and occupations demanding constant bending of the neck, are at a high risk of experiencing changes in their cervical spine³.

Poor posture: Watching TV in abnormal positions, holding phone or mobile on the shoulder, stooping of shoulder while sitting or walking, and sleeping in sitting position while traveling long distances may put stress on your cervical spine³.

Genetics: Cervical spondylitis or the tendency of degeneration of the bones may run in the families³.

Sedentary lifestyle: Tendency of putting on weight, obesity, or lack of exercise may lead to cervical spondylitis³.

Smoking: Smoking can be one of the risk factors for early degeneration and the development of cervical spondylitis³.

The most common evidence of degeneration can be found at C5-C6, C6-C7, and C4-C5^1.In cervical spondylosis, the intervertebral discs get thinner, dehydrated, and lose their ability to absorb the shock. The edges of the vertebrae develop bone spurs known as osteophytes. ¹

Initially, the patients may not experience symptoms at all, while a few may experience pain and stiffness in the neck, shoulder, and hands. These symptoms occur due to the inflammation of soft tissues and ligaments between the vertebrae and due to the formation of osteophytes².

Later, these changes can put pressure on nearby nerve roots resulting in pain, tingling sensation, or numbness in the upper extremities².

The degeneration of vertebrae, intervertebral discs, and abnormal growth (osteophytes), later, can cause narrowing of the spinal column (opening where spinal nerves exit) leading to a condition called cervical spinal stenosis or spinal canal stenosis. ¹

CLINICAL FEATURES
Pain and stiffness: This is the commonest presenting symptom, initially intermittent but later persistent. Occipital headache may occur if the upper-half of the cervical spine is affected

Radiating pain: Patient may present with pain radiating to the shoulder or downwards on the outer aspect of the forearm and hand. There may be paresthesia in the region of a nerve root, commonly over the base of the thumb (along the C6 nerve root). Muscle weakness is uncommon.

Giddiness: Patient may present with an episode of giddiness because of vertebro-basilar syndrome.

EXAMINATION – There is loss of normal cervical lordosis and limitation in neck movements. There may be tenderness over the lower cervical spine or in the muscles of the para-vertebral region (myalgia). The upper limb may have signs suggestive of nerve root compressionusually that of C6 root involvement.

RADIOLOGICAL FINDINGS

X-RAYS OF THE CERVICAL SPINE (AP and lateral) are sufficient in most cases. Following radiological features may be present

Narrowing of intervertebral disc spaces (most commonly between C5 -C6).

Osteophytes at the vertebral margins, anteriorly and posteriorly. Narrowing of the intervertebral foramen in cases presenting with radicular symptoms, may be best seen on oblique views.

MYELOGRAPHY, WITH COMPUTED TOMOGRAPHY (CT) SCANNING:

• This was previously considered to be the imaging test of choice for assessing spinal and foraminal stenosis.
• Myelography adds anatomic information in evaluating spondylosis.
• Myelography may be especially useful in visualizing the nerve root takeoff.
• CT scanning, with or without intrathecal dye, can be used to estimate the diameter of the canal.
• CT scans may demonstrate small, lateral osteophytes and calcific opacities in the middle of the vertebral body.

MRI

• It is a considerable advance in the use of imaging to diagnose cervical spondylosis.
• Increased accuracy in evaluating intrinsic spinal cord diseases.
• High–signal-intensity lesions can be seen on magnetic resonance images of spinal cord compression; this finding indicates a poor prognosis.
• False-positive and false-negative MRI results occur frequently in patients with cervical radiculopathy; therefore, MRI results and clinical findings should be used when interpreting root compression.

COMPLICATIONS:

Cervical myelopathy – Can cause disabilities, which are categorized as follows

• Grade 0 – Root signs and symptoms, with no evidence of cord involvement, are observed.
• Grade I – Signs of cord involvement is present, but the patient’s gait is normal.
• Grade II – Mild gait involvement is present, and the patient may be employed.
• Grade III – Gait abnormality prevents the patient’s employment.
• Grade IV – Ambulation is possible only with assistance.
• Grade V – The patient is chair-bound or bedridden.

Paraplegia

Tetraplegia

Recurrent chest infection

Pressure sores.

DIFFERENTIAL DIAGNOSIS

(i) Other causes of neck pain such as infection, tumors and cervical disc prolapse

(ii) Other causes of upper limb pain like Pancoast tumors, cervical rib, spinal cord tumors, carpal tunnel syndrome etc.

TREATMENT
Principles of treatment: The symptoms of cervical spondylosis undergo spontaneous remissions and exacerbations. Treatment is aimed at assisting the natural resolution of the temporarily inflamed soft tissues. 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. a) Proper neck posture: Patient must avoid situations where he has to keep his neck in one position for a long time. Only a thin pillow should be used at night.
2. b) Neck muscle exercises: These help in improving the neck posture.

During an episode of acute exacerbation, the following treatment is required:

• Hot fomentation
• Rest to the neck in a cervical collar
• Traction to the neck if there is stiffness

DIET: Calcium, phosphorous, vitamin D and a host hormone dietary and emotional factors plays a major role in integrity of locomotor system

Consume fish, nuts, oil seeds rich in omega 3 fatty acid and vitamin E

Fruits and vegetable-vitamin C and vitamin A fruits and vegetable fight against free radicals responsible for inflammatory and help to reduce pain and swelling.

Avoid red meat, potato, coffee as it increases acid load in body

REHABILITATION PROGRAM

PHYSICAL THERAPY
Immobilization of the cervical spine is the mainstay of conservative treatment for patients with severe cervical spondylosis with evidence of myelopathy. Immobilization limits the motion of the neck, thereby reducing nerve irritation. Soft cervical collars are recommended for daytime use only, but they are unable to appreciably limit the motion of the cervical spine.

Moulded cervical pillows can better align the spine during sleep and provide symptomatic relief for some patients.

Mechanical traction is a widely used technique. This form of treatment may be useful because it promotes immobilization of the cervical region and widens the foramina openings.

The use of cervical exercises has been advocated in patients with cervical spondylosis.

Isometric exercises are often beneficial to maintain the strength of the neck muscles. Neck and upper back stretching exercises, as well as light aerobic activities, also are recommended. The exercise programs are best initiated and monitored by a physical therapist.

Passive modalities generally involve the application of heat to the tissues in the cervical region, either by means of superficial devices (e.g., moist-heat packs) or mechanisms for deep-heat transfer (e.g., ultrasound, diathermy).

Manual therapy, such as massage, mobilization, and manipulation, may provide further relief for patients with cervical spondylosis. Mobilization is performed by a physical therapist and is characterized by the application of gentle pressure within or at the limits of normal motion, with the goal of increasing the range of motion. Manual traction may be better tolerated than mechanical traction in some patients. Manipulation is characterized by a high-velocity thrust,

This is often delivered at or near the limit of the range of motion. The intention is to increase articular mobility or to realign the spine.

OCCUPATIONAL THERAPY
Lifestyle modifications may involve an evaluation of workplace ergonomics, postural training, neck-school therapy (supervised, small-group therapy), stress management, and vocational assistance. Disability can be improved with specific strengthening exercises of the upper extremities, special splinting to compensate for weakness, and the use of assistive devices that allow the patient to perform previously impossible activities.

RECREATIONAL THERAPY

• Help the patient maintain his/her physical strength, social skills, and motivation
• Assist the patient and family in adjusting to the disability
• Decrease the patient’s atypical behaviours.
• Increase the patient’s independence.

SECTOR TOTALITY: Sector totality / Presenting complaints are the symptoms with location, sensations, modalities including causation & concomitant.

CONSTRUCTION OF SECTOR TOTALITY

1. LOCATION
2. SENSATION
3. MODALITY
4. CONCOMITTANT

SECTOR TOTALITY OF cervical spondylosis:

Location: Locomotor system, neck to B/L shoulder

Sensation: pain, tingling, numbness, weakness, lack of coordination.

Modality/ Causation: Neck injuries, Work-related activities, Poor posture, familial tendency, smoking, sedentary lifestyle, aggravating factors and ameliorating factors.

Concomitant: Fatigue, Disturbed sleep, loss of bladder or bowel control.

HOMEOPATHIC MANAGEMENT:
The pathological changes occurring in the cervical spondylosis are irreversible. Homeopathic medicines treat the underlying causes of the diseases. So, the treatment for this basically aimed at preventing further damage and the complications arising as a result of cervical spondylosis, and also improving the quality of life of the patient. These are some the homeopathic medicines that are used for the management of cervical spondylosis.

Cocculus Indicus
Spasmodic constriction in the length of the spine; worse on motion. Stitches in shoulder joint and muscles of upper arm and during rest. Painful stiffness of heels when moving it. Disabling and drawing in the small of the back.Vertigo as from intoxication or with inclination to vomit when rising up in bed, must lie down.sensation of crackling or stiffness of vertebrae. Pain in the neck on moving head as if cervical vertebrae were stiff. Stiffness of cervical muscles and great weakness, spinal irritation. Weakness of cervical muscles with heaviness of head.Stiff pain in cervical muscles on moving neck and on yawning. Stitching between scapular and in small of back.Pressure in scapula and nape of neck. Sensation as if paralyzed in back and neck.Sensitiveness of vertebrae to touch, but cannot locate the pain. Constant pain the back.crackling of vertebrae of neck, during movement. Weakness of the muscle of the neck, which are inadequate to support by the head. Red spots on the neck. Paralytic tearing in the back and in the loins. Pulling and tearing in the back especially when speaking, walking and stooping. Tremor in the back. Shooting between the shoulder blades and in the loins. weakness of cervical muscle, with heaviness of the head, for several days, the cervical muscle seems unable to support the head; is obliged to lay the head. Cervical muscles painful; most relieved when leaning backwards. Stiff pain in the cervical muscle, on moving the neck and yawning. Painful crackling in the cervical vertebrae, on moving the head. Paralytic drawing in the side of the neck and the other places. At times almost like an intermitting paralytic pressure. Sticking pain in the neck, on moving the head forward and backward; fine stiches externally, in the left side of the neck.

Hypericum
Pain in nape of neck. Pressure over sacrum. Spinal concussion. Coccyx injury from fall, with pain radiating up spine and down limbs. Jerking and twitching of muscles.Darting pain in shoulders. Pressure along ulnar side of arm. Pain in toes and fingers, especially in tips. Crawling in hand and feet. Lancinating pain in upper and lower limbs. Neuritis, with tingling, burning pain, numbness and flossy skin. Joints feel bruised. Hysterical joints. Tetanus (Physost; Kali brom). Traumatic neuralgia and neuritis.

Rhus tox –Pain between shoulders on swallowing. Pain and stiffness in small of back; better, motion, or lying on something hard; worse, while sitting. Stiffness of the nape of the neck.

Extremities are hot, painful swelling of joints. Pains tearing in tendons, ligaments, and fasciae. Rheumatic pains spread over a large surface at nape of neck, loins, and extremities; better motion (Agaric). Soreness of condyles of bones. Limbs stiff paralyzed. The cold fresh air is not tolerated; it makes the skin painful. Pain along ulnar nerve. Tearing down thighs. Sciatica; worse, cold, damp weather, at night. Numbness and formication, after overwork and exposure. Paralysis; trembling after exertion. Tenderness about knee-joint. Loss of power in forearm and fingers; crawling sensation in the tips of fingers. Tingling in feet.

Rananculus bulbous- The pain is felt over the neck portion and sometimes spread downwards and chest portion too. There is more pain during the morning hours and any sort of movement aggravates the pain. Moving the head also causes pain even a deep breathing increases the pain. The pain is associates with numbness feeling of arms. Like cimicifuga the pain is also originated after a long time of writing on laptop key board, I-pad, or mobile.

Kalmia- Pain from neck down arm; in upper three dorsal vertebrae extending to shoulder-blade. Pain down back, as if it would break; in localized regions of spine; through shoulders. Lumbar pains, of nervous origin. Deltoid rheumatism especially right. Pains from hips to knees and feet. Pains affect a large part of a limb, or several joints, and pass through quickly. Weakness, numbness, pricking, and sense of coldness in limbs. Pains along ulnar nerve, index finger. Joints red, hot, swollen. Tingling and numbness of left arm.

Colocynth- There is pain in the cervical or neck portion which is very much relieved by pressure or massage on that area. The characteristic symptom in colocynth to prescribe in cervical spondylosis is pain arise after some emotional disturbances like getting anger or being offended that impact in his sentiment or suppression of the anger. Those play a trigger factor to start neck pain.

Calcarea phos- -Rheumatic pain from draught of air, with stiffness and dullness of head. Soreness in sacro-iliac symphysis, as if broken (Aesc hip).Stiffness and pain, with cold, numb feeling, worse any change of weather. Crawling and coldness. Buttocks, back and limbs asleep. Pains in joints and bones. Weary when going upstairs. Osteophytes growth on the vertebral portion due to osteoarthritis changes. Pain is more during a damp humid weather. Along with clcarea phos the calcarea flour also helpful in bony changes of cervical vertebraes

REFERENCE:

1. Munjal, Y., n.d. API textbook of medicine. 10th ed.
2. Davidson’s Principle and Practice of Medicine: 23rd ed: 2018
3. Boericke William, New Manual of Homoeopathic Materia Medica with Repertory. Bjain Publishers Ltd
4. Clark J.H ;Dictionary of practical materiamedica
5. Dash A. Cervical spondylosis and its homoeopathic.
6. Pandurangarao SU, Bhoyar SS, Ramchandra AD, Janarthanan S. Cervical spondylosis: a common finding in vertigo patients. International Journal of Otorhinolaryngology and Head and Neck Surgery. 2019 Jan;5(1):33
7. Kulkarni GS, Babhulkar S. Textbook of Orthopaedics and Trauma (4 Vols). Jaypee Brothers Medical Publishers; 2016.2632-2634p

Dr. SNEHA JNANAKSHEE H.R.
PG Scholar, Department of Organon of Medicine
Father Muller Homoeopathic Medical College
Deralakatte, Mangalore -575018.