Weng Rui, Lin Dongxin, Yang Han, Xie Siyuan, Chen Cairui, Yu Yaoshuai, Yang Geng, Xie Pusheng, Zhao Liang, Li Yikai, Huang Xuecheng
Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, 6001 Beihuan Avenue, Futian District, Shenzhen, Guangdong, 518000, China.
School of Traditional Chinese Medicine, Southern Medical University, 1023 Satai South Road, Baiyun District, Guangzhou, Guangdong, 510000, China.
BMC Musculoskelet Disord. 2025 Aug 2;26(1):745. doi: 10.1186/s12891-025-08991-4.
To investigate the biomechanical mechanism of cervical rotation manipulation (CRM) in different lateral bending positions.
A 27-year-old Asian male patient with cervical spondylotic radiculopathy due to left posterior cervical disc protrusion and compression of nerve roots was recruited. The CT scan data of his skull and cervical spine were extracted to construct finite element models of the skull and whole cervical spine. After model verification, the key parameters of CRM were loaded into the model, and the effects of CRM on the structure of cervical spine were analyzed.
In left lateral bending, neutral and right lateral bending positions, the maximum Mises stresses of C5/6 annulus fibrosus were 1.545, 0.951 and 0.917 Mpa, the maximum Mises stresses of nucleus pulposus were 0.168, 0.139 and 0.146 Mpa, and the maximum Mises stresses of facet joints were 3.973, 2.186 and 1.369 Mpa, respectively, and those of the spinal cord and nerve roots were 2.692, 2.547, and 3.150 Mpa respectively. Regarding the anterior displacement of the cervical intervertebral disc on the herniated side, the maximum values were 1.060, 1.067, and 0.865 mm respectively. For the area of the intervertebral foramen on the affected sidearea, it was 34.393 mm² before the manipulation, and after the manipulation, it was 39.588, 39.724, and 41.668 mm² under the three positions respectively.
In CRM, the neutral position enlarges the intervertebral foramen volume and reduces intervertebral disc stress, with low spinal cord and nerve root stress and injury risk. In the right lateral bending position (lateral bending on the healthy side), the stresses in the annulus fibrosus and facet joints are minimal, and the intervertebral foramen expansion is most obvious, but the stresses in the spinal cord and nerve roots are the highest. In the left lateral bending position (lateral bending on the herniated side), the stresses in the intervertebral disc and facet joints are the highest, but it is conducive to the anterior displacement of the herniated intervertebral disc and enables smoother operation. Clinicians should select the appropriate operating position according to the actual situation.
探讨颈椎旋转手法（CRM）在不同侧屈位的生物力学机制。
招募一名27岁因左后颈椎间盘突出压迫神经根导致神经根型颈椎病的亚洲男性患者。提取其头颅和颈椎的CT扫描数据，构建头颅和全颈椎的有限元模型。模型验证后，将CRM的关键参数加载到模型中，分析CRM对颈椎结构的影响。
在左侧屈、中立位和右侧屈位时，C5/6纤维环的最大米塞斯应力分别为1.545、0.951和0.917兆帕，髓核的最大米塞斯应力分别为0.168、0.139和0.146兆帕，小关节的最大米塞斯应力分别为3.973、2.186和1.369兆帕，脊髓和神经根的最大米塞斯应力分别为2.692、2.547和3.150兆帕。关于突出侧颈椎间盘的前移位，最大值分别为1.060、1.067和0.865毫米。对于患侧椎间孔面积，手法操作前为34.393平方毫米，手法操作后，在三个位置下分别为39.588、39.724和41.668平方毫米。
在CRM中，中立位可扩大椎间孔容积并降低椎间盘应力，脊髓和神经根应力及损伤风险较低。在右侧屈位（向健侧侧屈）时，纤维环和小关节的应力最小，椎间孔扩大最明显，但脊髓和神经根的应力最高。在左侧屈位（向突出侧侧屈）时，椎间盘和小关节的应力最高，但有利于突出椎间盘的前移位且操作更顺畅。临床医生应根据实际情况选择合适的操作体位。
