Spine Center of Manipulative Orthopedics, Air Force Medical Center, Beijing, 100142, China.
Department of Bone and Joint Imaging Diagnosis, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, 100102, China.
Chin J Integr Med. 2022 Jun;28(6):518-523. doi: 10.1007/s11655-021-3276-y. Epub 2021 Sep 29.
To compare the analgesic effects of two types of spinal manipulation (SM) in acute lumbar radiculopathy (ALR) model rats induced by self-transplantation of autologous nucleus pulposus (ANP), and clarify the therapeutic mechanism.
Totally 108 male Sprague-Dawley rats were randomly divided into 6 groups by a random number table (18 rats in each group), including a blank group with no interference, a sham operation group with a surgery by making a local soft tissue incision on the left side of L5-6 vertebral segment, a model group with ALR of L5 extraforaminal nerve by ANP self-transplantation without other interference, a sham manipulation (SMA) group with simulating physical rotation, as well as a mobilization (MOB) group with simulating low-velocity and variable-amplitude rotation and a manipulation (MAN) group with simulating high-velocity and low-amplitude rotation. The interventions in SMA, MOB, and MAN groups started 1 day after modeling followed by another 5 treatments at days 3, 5, 8, 10 and 12. Rats in the other 3 groups did not receive any special intervention. Behavioral pain tests of 50% mechanical pain withdrawal threshold (50% PWT) and paw withdrawal latency (PWL) were conducted 1 day before operation followed by another 10 tests on days 1-7, 10, 12 and 14. Immunohistochemical expression of nitric oxide synthase (NOS) was investigated on days 5 and 12 after operation.
After 3 experimental SM interventions, 50% PWT and PWL were higher in the MAN group than the SMA group on days 6 and 7, and higher on days 10, 12 and 14 postoperatively (P<0.05 or P<0.01), while the same indices were significantly higher in the MOB group than MAN group on days 1-4 (P<0.05 or P<0.01). The expression of NOS was lower in the MAN and MOB groups than SMA group on day 12 postoperatively (P<0.01).
Both manipulation and mobilization produced better results than sham interference in relieving pain by reducing neuroinflammation possibly. At the early period, compared with manipulation, mobilization presented less sensitive response to pain until later visit. SM may inhibit the overexpression of NOS, thereby alleviating severe radiculopathy.
比较两种类型的脊柱手法（SM）治疗自体髓核移植（ANP）诱导的急性腰椎神经根病（ALR）模型大鼠的镇痛效果，并阐明其治疗机制。
108 只雄性 Sprague-Dawley 大鼠采用随机数字表法分为 6 组（每组 18 只），空白组不进行任何干预，假手术组在左侧 L5-6 椎骨段进行局部软组织切口手术，模型组采用 ANP 自体移植不进行其他干预造成 L5 椎间孔外神经 ALR，模拟物理旋转的假手法（SMA）组，模拟低速度、大振幅旋转的松动（MOB）组，模拟高速度、低振幅旋转的手法（MAN）组。SMA、MOB 和 MAN 组在造模后 1 天开始干预，连续干预 5 次，分别在第 3、5、8、10 和 12 天。其他 3 组不进行任何特殊干预。术前 1 天和术后第 1、3、5、7、10、12、14 天分别进行 50%机械痛觉退缩阈值（50%PWT）和足底退缩潜伏期（PWL）行为疼痛测试。术后第 5 和 12 天进行一氧化氮合酶（NOS）免疫组织化学表达检测。
3 次实验性 SM 干预后，MAN 组在第 6 和 7 天的 50%PWT 和 PWL 高于 SMA 组，术后第 10、12 和 14 天也高于 MAN 组（P<0.05 或 P<0.01），而 MOB 组在第 1-4 天的上述指标均显著高于 MAN 组（P<0.05 或 P<0.01）。术后第 12 天，MAN 和 MOB 组 NOS 表达均低于 SMA 组（P<0.01）。
与假干预相比，手法和松动均能通过减轻神经炎症来更好地缓解疼痛。在早期，与手法相比，松动对疼痛的反应不太敏感，直到后期就诊时才出现。SM 可能通过抑制 NOS 的过度表达，从而缓解严重的根性病变。
