Long term follow-up of cervical intervertebral disc herniation inpatients treated with integrated complementary and alternative medicine: a prospective case series observational study

Abstract

BackgroundSymptomatic cervical intervertebral disc herniation (IDH) presenting as neck pain accompanied by arm pain is a common affliction whose prevalence continues to rise, and is a frequent reason for integrative inpatient care using complementary and alternative medicine (CAM) in Korea. However, studies on its long term effects are scarce.MethodsA total 165 patients with cervical IDH admitted between January 2011 and September 2014 to a hospital that provides conventional and Korean medicine integrative treatment with CAM as the main modality were observed in a prospective observational study. Patients underwent CAM treatment administered by Korean medicine doctors (KMDs) in accordance with a predetermined protocol for the length of hospital stay, and additional conventional treatment by medical doctors (MDs) as referred by KMDs. Short term outcomes were assessed at discharge and long term follow-ups were conducted through phone interviews after discharge. Numeric rating scale (NRS) of neck and radiating arm pain, neck disability index (NDI), 5-point patient global impression of change (PGIC), and factors influencing long term satisfaction rates in PGIC were assessed.ResultsOf 165 patients who received inpatient treatment 20.8 ± 11.2 days, 117 completed the long term follow-up up at 625.36 ± 196.7 days post-admission. Difference in NRS between admission and discharge in the long term follow-up group (n = 117) was 2.71 (95 % CI, 2.33, 3.09) for neck pain, 2.33 (95 % CI, 1.9, 2.77) for arm pain, and that of NDI 14.6 (95 % CI, 11.89, 17.32), and corresponding scores in the non-long term follow-up group (n = 48) were 2.83 (95 % CI, 2.22, 3.45) for neck pain, 2.48 (95 % CI, 1.84, 3.12) for arm pain, and that of NDI was 14.86 (95 % CI, 10.41, 19.3). Difference in long term NRS of neck pain and arm pain from baseline was 3.15 (95 % CI, 2.67, 3.64), and 2.64 (95 % CI, 1.99, 3.29), respectively. PGIC was reported to be “satisfactory” or higher in 79.5 % of patients at long term follow-up.ConclusionsThough the observational nature of this study limits us from drawing a more decisive conclusion, these results suggest that integrative treatment focused on CAM in cervical IDH inpatients may achieve favorable results in pain and functional improvement.Trial registrationClinicalTrials.gov Identifier: NCT02257723. Registered October 2, 2014.

Survey of Integrative Treatment Practices of Korean Medicine Doctors for Cervical Disc Herniation: Preliminary Data for Clinical Practice Guidelines

“…Korea employs a dual medical system that utilizes both conventional and Korean medicine. Spine-specialty Korean medicine hospitals as certified by the Korean Ministry of Health and Welfare treat various musculoskeletal disorders using nonsurgical integrative medicine techniques including acupuncture, herbal medicine, Chuna manual therapy, and pharmacopuncture [13–15, 27] and operate an integrative treatment model collaboratively with conventional medicine for effective diagnosis (e.g., X-rays, MR images, CT, DITI, and clinical laboratory tests) and pain control means (e.g., oral analgesics, epidural injections, and physiotherapy). This study aimed to establish and propose a model of integrative usual care that may be of reference to CDH practitioners and researchers through concurrent and comprehensive reporting of the clinical experience and practice patterns for CDH of KMDs practicing at spine-specialty Korean medicine hospitals.…”

“…Korea operates a specialty hospital system where the Minister of Health and Welfare designates hospitals that perform high-proficiency medical procedures for specific diseases or medical specialties as selecting specialty hospitals (Article 3, Section 5 of Korean medical law). Spine-specializing Korean medicine hospitals offer various nonsurgical Korean medicine treatments such as acupuncture, herbal medicine, Chuna manual therapy, and pharmacopuncture, and while the effects of treatment have been attested to in various studies [12–14], few studies on nonconventional treatments including Korean medicine have been conducted with specific focus on CDH treatment as diagnostic imaging with magnetic resonance imaging (MRI) or computed tomography (CT) scans are required to be diagnosed with CDH, in which tools may not be readily available at most Korean medicine facilities [15]. There is also a continued lack of data on treatment trends and healthcare provider and stakeholder dispositions toward nonsurgical integrative treatment.…”

The impact of uncertainty in society on the use of traditional, complementary and alternative medicine: a comparative study on visits to alternative/traditional/folk health care practitioners

“…The prevalence of TCAM usage in EU countries also varied widely, between 0.3 and 86% [9], as well as in Asian countries. According to a national telephone survey conducted in 2001 for the general population in Japan, the proportion of TCAM usage was 76% [10], and in South Korea, 71.3% of people reported having had at least one TCAM therapy during the previous 12 months [11]. According to a national health interview survey of the general population in Taiwan in the same year, the proportion of TCAM usage was 31.8% among men and 22.4% among women [12].…”

Ranges of Cervical Intervertebral Disc Deformation During an In Vivo Dynamic Flexion–Extension of the Neck

“…Cervical spine disc diseases are common among adults and reach a prevalence of nearly 95% by the age of 65 yr [1]. Neck pain is the most frequently seen symptom in clinic [2,3] and is commonly attributed to cervical disc diseases [4]. In severe conditions, disc diseases can result in instability, neurologic deficit, spinal stenosis, facet dysfunction, and less cervical lordosis [5][6][7][8][9].…”