Clinical Efficacy and Safety of "Three-Dimensional Balanced Manipulation" in the Treatment of Cervical Spondylotic Radiculopathy by Finite Element Analysis

Abstract

Cervical spondylotic radiculopathy (CSR) is the most commonly encountered cervical spine disorder. Cervical manipulation has been demonstrated as an effective therapy for patients. However, the mechanisms of manipulations have not been elucidated. A total of 120 cervical spondylotic radiculopathy patients were divided into the "three-dimensional balanced manipulation" treatment group (TBM group) and control group randomly. The control group was treated with traditional massage; the TBM treatment group was treated with "three-dimensional balanced manipulation" based on traditional massage. The symptoms and clinical efficacy of the patients were compared before and after treatment for one month. A three-dimensional finite element model was established. The mechanical parameters were imported to simulate TBM, and finite element analysis was performed. The results showed that the total effective rate was significantly higher in the TBM group compared with the control group. The biomechanical analysis showed the vertebral body stress was mainly distributed in the C3/4 spinous processes; the deformation mainly concentrated in the anterior processes of the C3 vertebral body. The intervertebral disc stress in the C3~C7 segment was mainly distributed in the anterior part of the C3/4 intervertebral disc, and the deformation extends to the posterior part of the C3/4 nucleus pulposus. In summary, these data are suggesting that TBM was effective in CSR treatment. The results of the finite element model and biomechanical analysis provide an important foundation for effectively avoiding iatrogenic injuries and improving the effect of TBM in the treatment of CSR patients.

Figure 1

“Three-dimensional balanced manipulation” was effective in treating cervical spondylotic radiculopathy. (a) Visual Analogue Scale of “three-dimensional balanced manipulation” group and control group before and after treatment. (b) The clinical efficiency and total effective rate in “three-dimensional balanced manipulation” group and control group. ^∗P < 0.05, ^∗∗P < 0.01.

Figure 2

Biomechanical analysis of the C3~C7 segment vertebral body in the process of “three-dimensional balanced manipulation.” (a) Stress distribution when the model was only loaded with a downward force of head gravity. (b) Stress distribution during head loading and upward traction. (c) Side view of the stress distribution of the vertebral body during the complete manipulation. (d) The overall model deformation distribution diagram when only the head gravity is loaded. (e) Distribution map of overall deformation when loading head and upward traction. (f) Side view of the distribution of vertebral body deformation under complete manipulation. (a–c) The color represents stress variety, red represents maximum stress, blue represents minimum stress, and from red to blue represents decreasing stress. (d–f) The color represents deformation variety, red represents maximum deformation, blue represents minimum deformation, and from red to blue means represents decreasing deformation.

Figure 3

Biomechanical analysis of the intervertebral disc in C3~C7 segments during the process of “three-dimensional balanced manipulation.” (a) Stress distribution when the model was only loaded with a downward force of head gravity. (b) Stress distribution during head loading and upward traction. (c) Side view of the stress distribution of the vertebral body during the complete manipulation. (d) Distribution map of the overall intervertebral disc deformation when only the head gravity is loaded. (e) Distribution of the overall disc deformation when the head is loaded and upward traction. (f) Deformation distribution of intervertebral disc under complete manipulation. (a–c) The color represents stress variety, red represents maximum stress, blue represents minimum stress, and from red to blue represents decreasing stress. (d–f) The color represents deformation variety, red represents maximum deformation, blue represents minimum deformation, and from red to blue represents decreasing deformation.