Cervical Spondylosis & Its Homoeopathic Management

GUIDED BY:

PROF.(DR.) MANOJ YADAV

N.H.M.C.,LUCKNOW SUBMITTED BY:

ABHAY SINGH
BATCH 200

Cervical Spondylosis & Its Homoeopathic Management

GUIDED BY:

PROF.(DR.) MANOJ YADAV

N.H.M.C.,LUCKNOW

SUBMITTED BY:

ABHAY SINGH
BATCH 200

ACKNOWLE !EMEN "

I hereby take this opportunity to extend my gratitude to all the teachers at National Homoeopathic MedicalCollege# L$c%no& without whose support and guidance completion of this project would not have been possible. I thank my project in charge

'ro()* r)+Mano, -adav

for her guidance in making this project.

Above

all

am

indebted

to

principal r).i%rama 'rasad without whose support I would not have been able to get this opportunity.
A/HA- SIN!H
Intern */atch 0112+

National Homoeopathic Medical College & Hospital #L$c%no&

Certi(icate 3y !$ide
I hereby certify that A3hay Singh of Batch 200 has prepared his dissertation file on the topic allotted to him!"#ervical $pondylosis%under my guidance and up to my satisfaction. &uring the course of preparation she showed keen interest in his work! I wish his success in life.

National Homoeopathic Medical College & Hospital # L$c%no&

Certi(icate 3y 'rincipal
'his is to certify that intern A3hay Singh of Batch 200 has properly completed his dissertation topic entitled "#ervical $pondylosis% under sincere guidance of 'ro()* r)+ Mano, -adav! (ational )omoeopathic *edical #ollege + )ospital ! ,ucknow. I wish him all the best + success in life.

*'4INCI'AL+ National Homoeopathic Medical College & Hospital #L$c%no&

IN E5
Contents 'age n$m3er
6) 0) IN"4O 7C"ION AIMS & O/8EC"I.ES

9) 4E.IEW O: LI"E4A"74E A) 4E.IEW O: !ENE4AL ME ICAL LI"E4A"74E /)4E.IEW O: HOMOEO'A"HIC ME ICAL LI"E4A"74E ;) MA"E4IAL & ME"HO S

<) MANA!EMEN" & HOMOEO'A"HIC "4EA"MEN" 2) ANNE574E A) CASE :O4MA"ION /) !4A'HS C) S-NO'SIS O: CASES

=)

/I/LIO!4A'H-)

INTRODUCTION

The significance of a fact is measured by the capacity of the observer. Every teacher or student of Homoeopathy sees the same facts in the drugs but in his evaluation and experience he emphasizes certain aspects which may be completely ignored by another person. This is why the richness of our Homoeopathy is increased by contributions of different masters. It is not always, in the present state of our knowledge, that we can give absolute, characteristic contrast. It is easy to differentiate where remedies diverge similar remedies but difficult to nicely discriminate where until their symptoms are almost converge,

identical and yet, !ust here individualization is most needed. "ailures arise first from defective !udgment secondly from

imperfect provings, thirdly from imperfect clinical reports fourthly from an imperfect comprehension of what symptoms should be compared.

AIMS & OBJECTIVES

To see the place of deep acting and short acting medicines in treatment.

To see Homoeopathic dosage directions.

To see miasmatic and constitutional background in the treatment.

To see the auxiliary management in the treatment.

REVIEW OF LITERATURE
REVIEW OF GENERAL MEDICAL LITERATURE
ANATOMY OF CERVICAL VERTEBRAE
There are seven cervical vertebrae, out of which the third to sixth are typical, while the #st, $nd and %th are atypical.

TYPICAL CERVICAL VERTEBRAE

(A) The body
It is small and broader from side to side than from before backwards. Its superior surface is concave transversely with

upward pro!ecting lips on each side. The inferior surface is saddle shaped, being convex from side to side and concave from before backwards. The lateral borders are beveled and from synovial !oints with the pro!ecting lips of the next lower vertebra. The anterior border pro!ects downwards and may hide the intervertebral disc. The anterior and posterior surfaces resemble those of other vertebrae.

(B) Vertebral foramen It is larger than the body. It is triangular in shape because the pedicles are directed backwards and laterally. (C) Vertebral arch The pedicles are directed backwards and laterally. The superior and inferior vertebral notches are of e&ual size. The laminae are relatively long and narrow, being thinner above than below. The superior and inferior articular processes form articular pillars which pro!ect laterally at the !unction of the pedicle and the

lamina. The superior articular facets are flat. They are directed backwards and upwards. The inferior articular facets are also flat but are directed forwards and downwards.

The transverse processes are pierced by foramina transversaria. Each process has anterior and posterior roots which end in tubercles !oined by the costotransverse bar. The costal element is represented by the anterior root, the costotransverse bar and the posterior tubercle. The anterior tubercle of the 'th cervical vertebra is large and is called the carotid tubercle because the common carotid artery can be compressed against it. The spine is short and bifid.

ATTACHMENTS AND RELATIONS (1) The anterior and posterior longitudinal ligaments are

attached to the upper and lower borders of the body in front and behind, respectively. (n each side of the anterior longitudinal ligament the vertebral part of the longus colli is attached to the anterior surface. The posterior surface has two or more foramina for passage of basivertebral veins. ( ) The upper borders and lower parts of the anterior surfaces of the lamina provide attachment to the ligament flava. (!) The foramen transversarium transmits the vertebral artery, the vertebral veins and a branch from the inferior cervical ganglion. The anterior tubercles give origin to the scalenus anterior, the longus capitis, and the obli&ue part of the longus colli. (") The costotransverse bars are grooved by the anterior primary rami of the corresponding cervical nerves. (#) The posterior tubercles give origin to the scalenus medius and posterior, the levator scapulae, the splenius cervicis, the longitudinal cervicis and the iliocostalis cervicis. ($) The spine gives origin to the deep muscles of the back of the neck )interspinalis, semispinalis thoracis, spinalis cervicis and multifidus.* %IRST CERVICAL VERTEBRA

It is called the atlas. It is ring shaped. It has no body. It also has no spine. The atlas has a short anterior arch, a long posterior arch, right and left lateral masses and transverse processes. The anterior arch is marked by a median anterior tubercle on its anterior aspect. Its posterior surface bears an oval facet which articulate with the dens.

The posterior arch forms about two fifths of the ring end is much longer than the anterior arch. Its posterior surface is marked by a median posterior tubercle. The upper surface of the arch is marked )behind the lateral mass* by a groove. Each lateral mass shows the following important features. Its upper surface bears the superior articular facet. This articular facet is elongated )forward and medially*, concave and is directed upwards and medially. It articulates with the corresponding condyle to form an atlanto+occipital !oint. The lower surface is marked by the inferior articular facet. This facet is nearly circular,

more or less flat and is directed downwards, medially and backwards. It articulates with the corresponding facet on the axis vertebra to form an atlantoaxial !oint. The medial surface of the lateral mass is marked by a small roughened tubercle. The transverse process pro!ects laterally from the lateral mass. It is unusually long and can be felt on the surface of the neck between the angle of the mandible and the mastoid process. Its long length allows it to act as an effective lever for rotatory movements of the head. The transverse process is pierced by the foramen transversarium. ATTACHMENTS AND RELATIONS (1) The anterior tubercle provides attachments to the anterior longitudinal ligaments, and provides insertion to the upper obli&ue part of the longus colli. ( ) The upper border of the anterior arch gives attachment to the anterior atlanto+occipital membrane. (!) The lower border of the anterior arch gives attachment to the lateral fibers of the anterior longitudinal ligaments. (") The posterior tubercle provides attachment to the ligamentun nuchae and gives origin to the rectus capitis posterior minor )on each side*. (#) The groove on the upper surface of the posterior arch is occupied by the vertebral artery and by the first cervical nerve.

,ehind the groove the upper border of the posterior arc gives attachment to the posterior atlanto+occipital membranes. ($) The lower border of the posterior arch gives attachment to the highest pair of ligamentum flava. (&) The tubercle on the medial side of the lateral mass gives attachment to the transverse ligament of the atlas. (') The anterior surface of the lateral mass gives origin to the rectus capitis anterior. (() The transverse process gives origin to the rectus capitis lateralis )upper surface anteriorly*, the superior obli&ue )upper surface posteriorly*, the inferior obli&ue )lower surface of the tip*, the levator scapulae )lateral margin and lower border*, the splenius cervicis and the scalenus medius. SECOND CERVICAL VERTEBRA It is called the axis. It is identified by the presence of the dens )odontoid process* which is a strong tooth like process pro!ecting upwards from the body. The den is usually believed to represent the centrum )body* of the atlas which has fused with the centrum of the axis.

(A) BOD) AND DENS The superior surface of the body is fused with the dens and is encroached upon on each side by the superior articular facets. The dens articulate anteriorly with the anterior arch of the atlas and posteriorly with the transverse ligament of the atlas. The inferior surface has a prominent anterior margin which pro!ects downwards. The anterior surface presents a median ridge on each side of which there are hollowed out impressions.

(B) VERTEBRAL ARCH

The pedicles are concealed by the superior articular processes. The inferior surface presents a deep and wide inferior vertebral notch, placed in front of the inferior articular process. The superior vertebral notch is very shallow and is placed on the upper border of the lamina, behind the superior articular process. The lamina is thick and strong. Each superior articular facet occupies the upper surfaces of the body and of the massive pedicle. -aterally it overhangs the foramen transversarium. It is a large, flat, circular facet which is directed upwards and laterally. It articulates with the inferior facet of the atlas vertebra to form the atlanto+axial !oint. Each inferior articular facet lies posterior to the transverse process and is directed downwards and forwards to articulate with the .rd cervical vertebra. The transverse processes are very small and represent the true posterior tubercles only. The foramen transversarium is directed upwards and laterally.

The spine is large, thick and very strong. Its tip is bifid, terminating in two rough tubercles. ATTACHMENTS The dens provide attachment at its apex to the apical ligament and on each side to the alor ligaments. (1) The anterior surface of the body receives the insertion of the longus colli. The anterior longitudinal ligament is also attached to the anterior surface. ( ) The posterior surface of the body provides attachment, from below upwards, to the posterior longitudinal ligament, the membrana tectoria and the vertebral limb of the cruciate ligament. (!) The laminae provide attachment to the ligamentum flava.
(!) The transverse process gives origin by its tip to the

levator scapulae, the scalenus medius )anteriorly* and the splenius cervicis )posteriorly* . The intertransverse muscles are attached to the upper and lower surfaces of the process. (#) The spine gives attachment to the ligamentum the semispinalis cervicis, the rectus capitis ma!or, the inferior obli&ue the spinalis

nuchae posterior

cervicis, the interspinalis and the multifidus.

SEVENTH CERVICAL VERTEBRA It is also known as the vertebra prominent because of its long spinous process, the tip of which can be felt through the skin at the lower end of the nuchal furrow. Its spine is thick, long and nearly horizontal. It is not bifid, but ends in a tubercle.

The transverse processes are comparatively large in size absent. The foramen transversarium is relatively

the

posterior root is longer than the anterior. The anterior tubercle is small, sometimes double or may be entirely absent. ATTACHMENTS (1) The tip of the spine provides attachment to the ligamentum nuchae, the trapezius, the rhomboideus minor, the serratius posterior superior, the splanius

capitis, the semispinalis thoracis, the spinalis cervicis, the interspinalis and the multifidus. ( ) Transverse posterior process. The foramen transversarium to the

usually transmits only an accessory vertebral vein. The tubercle provides attachment suprapleural membrane. The lower border provides attachment to the levator costarum. (!) The anterior root of the transverse process may sometimes be separate. It then forms a cervical rib of variable size.

TYPICAL CERVICAL JOINTS BETWEEN THE LOWER SIX CERVICAL VERTEBRAE

These correspond in structure to typical intervertebral !oints. The only additional point to be noted is that in the cervical region the supraspinous ligaments are replaced by the ligamentum nuchae.

The ligamentum nuchae is triangular in shape. Its apex lies at the seventh cervical spine and its base at the external occipital crest. Its anterior border is attached to cervical spines, while the posterior border is free and provides attachment to the investing layer of deep cervical fascia. The ligament gives origin to the splenius, rhomboid and trapezius muscles.

SPECIAL JOINTS BETWEEN ATLAS, AXIS AND OCCIPITAL BONE

(1) The atlanto+occipital and the atlanto+axial !oints are designed to permit free movements of the head on the neck.
(2) The axis vertebra and the occipital bone are connected

together by very strong ligaments. ,etween these two bones, the atlas is held like a washer. The axis of movement between the atlas and skull is transverse, permitting flexion and extension, where as the axis of movement between the axis and atlas is vertical, permitting rotation of the head.

ATLANTO*OCCI+ITAL ,OINTS These are synovial !oints of the ellipsoid variety. ARTIC-LAR S-R%ACES. Abo/e. The occipital condyles, which are convex. Belo0. The superior articular surfaces of the atlas vertebra. These are concave. The articular surfaces are elongated, and are directed forwards and medially.

LI1AMENTS. (1) The fibrous capsule surrounds the !oint. It is thick posterolateral and thin anteromedially.
(2)

The anterior atlanto+occipital membrane extends from the anterior margin of the foramen magnum above to the upper border of the anterior arch of the atlas below. -aterally it is continuous with the anterior part of the capsular ligament, and anteriorly it is strengthened by the cord like anterior longitudinal ligament.

(!) The posterior atlanto+occipital membrane extends from the posterior margin of the foramen magnum above, to the upper border of the posterior arch of the atlas below. Inferolaterally it has a free margin which arches over the vertebral artery and the first cervical nerve. -aterally it is continuous with the posterior part of the capsular ligament.

MOVEMENTS. /ince these are ellipsoid !oints, they permit movements around axis. "lexion and extension occur around a transverse axis. /light lateral flexion is permitted around on anteroposterior axis.
(")

"lexion is brought about by the longus capitis and the rectus capitis anterior.

(2) Extension is done by the rectus capitis posterior ma!or and

minor, the obli&ue0s capitis superior, the semispinalis capitis, the splenius capitis and the upper part of the trapezius. (!) -ateral flexion is produced by the rectus capitis

lateralis, the semispinalis capitis, the splenius capitis, the sternomastoid and the trapezius. ATLANTO*A2IAL ,OINTS These !oints are comprised1 (1) 2 pair of lateral atlanto+axial !oints between the

inferior facets of the atlas and the superior facets of the axis. These are plane !oints. ( ) 2 median atlanto+axial !oint between the dens

)odontoid process* and the anterior arch and transverse process of the atlas. It is a pivot !oint. The !oint has two separate synovial cavities, anterior and posterior.

LI1AMENTS.
(#) The lateral atlanto+axial !oints are supported by a

capsular ligament all around, the lateral part of the anterior longitudinal ligament and the ligamentum flavor. (b) The median atlanto+axial !oint is strengthened by

the following+ )#* The anterior small part of the !oint between the anterior arch of the atlas and the dens is supported by a loose capsular ligament. )$* The posterior larger part of the !oint between the dens and the transverse ligament is often continuous with one of the atlanto+occipital !oints. Its main support is the transverse ligament which forms a part of the cruciform ligament of the atlas. The transverse ligament is attached on each side to the medial surface of the lateral mass of the atlas. In the median plane its fibers are prolonged upwards to the basioccipital and downwards to the body of the axis, thus forming the cruciform ligament of the atlas vertebra. The transverse ligament embraces the narrow neck of the dens and prevents its dislocation. MOVEMENTS.

3ovements at all three !oints are rotatory and take place around a vertical axis. The dens form a pivot around which the atlas rotates. The movement is limited by the alar ligaments. The rotatory movements are brought about by the obli&ues capitis inferior, the rectus capitis posterior ma!or and the splenius capitis of one side, acting with the sternomastoid of the opposite side. ANATOM) O% THE S+INAL CORD The spinal cord is the lower elongated, cylindrical part of the 45/. It occupies the upper two thirds of the vertebral canal. It extends from the level of the upper border of the atlas to the lower border of vertebra -#, or the upper border of vertebra -$.

It is about 67cm long. The lower is conical and is called the conus medullaris. The apex of the conus is continued down as the filum terminale. 2long its length, the cord presents two thickenings, the cervical and lumbar enlargements, which give rise to large nerves for the limbs. The spinal cord gives off .# pairs of spinal nerves.

INTERNAL STR-CT-RE. 8hen seen in transverse section the gray matter of the spinal cord forms an H shaped mass. In each half of the cord the gray matter is divisible into anterior gray column and posterior gray column. In some part of the spinal cord a small lateral gray column is also present. The gray matter of the right and left halves of the spinal cord is connected across the midline by the gray commisure which is traversed by the central canal.

The white matter of the spinal cord is divisible into right and left halves in front by a deep anterior median fissure and behind by the posterior median septum. In each half the white matter is

divided into )#* the posterior white column or posterior funiculus )$* the lateral white column or lateral funiculus and ).* the anterior white column or anterior funiculus. The white matter of the right and left sides is continuous across the midline through the white commisure which lies anterior to the grey commisure. The spinal cord gives attachment, on either side, to a series of spinal nerves. Each spinal nerve arises by two roots, )#* anterior or ventral )$* posterior or dorsal. Each root is made up of a number of rootlets. The length of the spinal cord giving origin to the rootlets for one spinal nerve constitutes one spinal segment.

2s the cord is much shorter than the length of the vertebral column the spinal segments do not lie opposite the corresponding vertebra. In estimating the position of a spinal segment in relation to the surface of the body it is important to remember that a vertebral spine is always lower than the corresponding spinal segment. 2s a rough estimate it may be stated that in the cervical region there is a difference of one segment in the upper thoracic region there is a difference of two segments and in the lower thoracic region there is a difference of three segments.

TRACTS O% THE S+INAL CORD 2 collection of nerve fibres that connects two masses of grey matter within the central nervous system is called a tract. Tracts may be ascending or descending. They are usually named after the masses of grey matter connected by them.

(A) DESCENDIN1 TRACTS )#* The corticospinal tract )$* The rubrospinal tract ).* The olivospinal tract )6* The vestibulospinal tract )7* The tectospinal tract )'* The lateral and medial reticulospinal tracts )%* 3edial longitudinal bundle (B) ASCENDIN1 TRACTS )#* Tracts in the posterior funiculus

"asciculus gracilis "asciculus cuneatus

)$* Tracts in the lateral funiculus

-ateral spinothalamic tract 2nterior and posterior spinocerebellar tracts

/pino+olivery tract /pinotectal tract

).* Tracts in the anterior funiculus

2nterior spinothalamic tract

ANATOM) O% S+INAL NERVES /pinal nerves connect the 45/ to receptors, muscles and glands and are part of the peripheral nervous system. The .# pairs of spinal nerves are named and numbered according to the region and the level of the spinal cord from which they emerge. The first cervical pair emerges between the atlas and the occipital bone. 2ll other spinal nerves emerge from the vertebral column through the intervertebral foramina between ad!oining vertebras. There are 9 pairs of cervical nerves, #$ pairs of thoracic, 7 pairs of lumbar, 7 pairs of sacral and # pair of coccygeal nerves. COM+OSITION AND COVERIN1S 2 typical spinal nerve has two separate points of attachments to the cord1 a posterior root and an anterior root. The posterior and anterior roots unite to form a spinal nerve at the intervertebral foramen. /ince the posterior root contains sensory fibres and the anterior root contains motor fibres, a spinal nerve is a mixed nerve, at least at its origin. The posterior root contains a ganglion in which cell bodies of sensory neurons are located.

The individual fibres whether myelinated or unmyelinated are wrapped in a connective tissue called the endoneurium. :roups of fibres with their fascicles and each bundle are wrapped in connective tissue called the perineurium. The outermost covering around the entire nerve is the epineurium. The duramater of spinal meninges fuses with the epineurium as the nerve exits through the intervertebral foramen.

+LE2-SES The ventral rami of spinal nerves, except for thoracic nerves T$+ T#$, do not go directly to the body structures they supply. Instead, they form networks on both left and right sides of the body by !oining with varying numbers of fibres from ventral rami of ad!acent nerves. /uch a network is called a plexus. The principal plexuses are the cervical plexus, brachial plexus, lumbar plexus and sacral plexus. Emerging from the plexuses are the nerves bearing names that are often descriptive of the general regions they serve or the course they take. Each of the nerves in turn may have several branches named for the specific structures they innervate.

CERVICAL +LE2-S The cervical plexus is formed by the ventral rami of the first four cervical nerves )4#+46* with contributions from 47. There is one

on each side of the neck along side the first four cervical vertebras. The cervical plexus supplies the skin and muscles of the head, neck and upper part of the shoulders. ,ranches of the cervical plexus also connect with cranial nerves ;# and ;#$. The phrenic nerves arise from the cervical plexuses and supply motor fibres to the diaphragm.

CERVICAL +LE2-S

NERVE

ORI1IN

DISTRIB-TION

S34erf5c5al or 6en6or7 branche6 -esser occipital 4$ /kin of scalp behind and above ear /kin in front, below and above ear and over parotid gland /kin over aspect of neck anterior

:reater auricular

4$+4.

Transverse cervical 4$+4.

/upraclavicular

4.+46

/kin over upper portion of chest and shoulder

CERVICAL +LE2-S

Dee4 or lar8el7 motor branche6 2nsa cervicalis +superior root +inferior root <hrenic 4# 4$+4. 4.+47 + Infrahyoid and geniohyoid muscles of neck + infrahyoid muscles of neck =iaphragm between thorax and abdomen =eep muscles of neck

/egmental branches 4#+47

BRACHIAL +LE2-S

The vertical rami of spinal nerves 47+49 and T# form the brachial plexus. The brachial plexus extends downward and laterally on either side of the last four cervical and first thoracic vertebra. It passes over the first rib behind the clavicle and then enters the axilla.

BRACHIAL +LE2-S

NERVE =orsal scapular

ORI1IN 47

DISTRIB-TION -evator rhomboideus minor muscles scapulae, ma!or amd

-ong thoracic 5erve to subclavius /uprascapular 3usculocutaneous

47+4% 47+4' 47+4' 47+4%

/erratus anterior /ubclavius muscles /upraspinatus infraspinatus muscles 4orachobrachialis, brachii muscle and biceps brachialis and

3edian)lateral head* -ateral pectoral ?pper subscapular Thoracodorsal -ower subscapular 2xillary

47+4%

"lexors of forearm, skin of lateral $>. of palm and fingers

47+4% 47+4' 4'+49 47+4' 47+4'

<ectoralis ma!or muscle /ubscapularis muscle -atissimus dorsi muscle /ubscapularis ma!or muscles =eltoid and teres minor, skin over deltoid and upper posterior aspect of arm and teres

@adial

47+49

and Extensors

of

arm

and

T# 3edial pectoral 3edialbrachial cutaneous 3edialantebrachial 49+T# cutaneous 3edian T# ?lnar 49+T# 49+T# 49+T#

forearm,

lateral

$>.

of

dorsum of hand <ectoralis ma!or and minor muscles 3edial and posterior aspect of lower third of arm 3edial and posterior aspect of forearm 47+49and "lexors of forearm, skin of lateral $>. of palm of hand and fingers "lexors carpi ulnaris, skin of medial side of hand, little finger and medial half of little finger

PHYSIOLOGY OF PAIN, TOUCH, THERMAL AND OTHER SENSES

THE +ATHO+H)SIOLO1) O% +AIN

<ain is produced when a nociceptive )in!urious* stimulus is received )the nociceptivr stimulus either causes actual damage or is a potentially damaging agent of the tissues*. The in!urious agent may be )#* 3echanical )cuts, blows etc*, )$* 4hemical )acids etc.*,).* Thermal)burn* or )6* =isease. The term Atenderness0 means, pain elicited by pressing the part. <ain is unpleasant sensation no doubt, but on the whole it is usually beneficial to the man. <ain makes us conscious of the presence of the in!urious agent and that is why we seek removal of the in!urious agent by appropriate measures. However, in some cases, the presence of pain may be counter productive to the interest of patient. The classical example is pain in incurable cases of cancers. RECE+TORS AND STIM-L-S ,are nerve terminals serve as pain receptor. However, other cutaneous receptors, when stimulated excessively, may cause pain. In the damaged tissues, particularly in the skin, some algogenic substances are released. These algogenic substances come in contact with the pain receptors pain is produced. <ossibly these substances are+)#*bradykinin )$* serotoninm ).*BC ions)6* 23< )7* acetylcholine. <rostaglandins are not very algogenic but they potentiate the algogenic power by serotonin and bradykinin.

PROPERTIES OF PAIN
(1)Thre6hol9 an9 5nten65t7 If intensity of the stimulus is below the threshold, pain is not felt. 2s the intensity increases more and more, pain is felt more and more and the pain sensation spreads. However if the mind is distracted, the threshold of pain increases. /evere excitement and emotion can altogether abolish even a severe pain. ( )A9a4tat5on <ain receptors show no adaptation and so the pain continues as long as the receptors continue to be stimulated. (!)Local56at5on of 4a5n <ain sensation is somewhat poorly localized. However, superficial pain is comparatively better localized than the deep pain. Disceral pain is usually reffered )ie felt at a place which is other than the area overlying the viscus*.

(")Infl3ence of the rate of 9ama8e on the 5nten65t7 of 4a5n If the rate of in!ury is high, intensity of pain is also high and vice versa. Therefore, a very slowly growing tissue damaging agent )e.g. 4ancer at early stage*, 3ay not produce any pain at all.

(#) %5r6t (4a6t) an9 6econ9 (6lo0) 4a5n 2fter receiving a nociceptive stimulus, two types of nerve fibres are stimulated. The 2/ fibres are somewhat thick and finely myelinated with a faster rate of conduction but 4 fibres are very thin and nonmyelinated with much slower rate of conduction. 4 type of fibres however outnumber the 2/ fibres. 8hen an in!ury is received both or any one of the groups of fibres may be stimulated )depending on the nature of stimulation*, but sensation due to the stimulation of 2/ fibres are felt earlier whereas that due to 4 fibres are felt after a long time)because of the slowness of conducting of 4 fibres*. They are called first or fast and second or slow pain respectively. ?sually, the pain due to 4 fibre stimulation is particularly unpleasant and outlasts the period of stimulation. /econd pain is also spoken of as pathological pain. ,esides the fast pain is better localized while the slow pain is not.

Ne3ro tran6m5tter an9 4ath of 4a5n (1) The tran6m5tter

The 2/ and the 4 terminate on the dorsal horn of the spinal cord. The first neuron ends here. 2lmost certainly the synaptic transmitter is substance <, secreted by the terminals of the 4 as well as fibres.

( )

The 4ath

The tip of the dorsal horn is called Asubstantia gelatinosa rolandi0. 2/ fibres and 4 fibres terminate at /:@. "rom the /:@, the next order neurons arise and cross to the opposite side and form the Aspinothalamic tract0. The /TT reaches ultimately the thalamus. "rom the thalamus, the next order neuron arises to end is the sensory cortex in the parietal lobe. /ome descending fibres from the brain terminate on the /:@. They constitute a tract that causes inhibition of pain. In the above description of the path of pain, it was assumed, that the pain arose from a somatic structure. ?nder some condition, pain can also arise from the viscera. 2bdominal visceral pain is carried by afferent sympathetic fibres. However cortical representation of visceral pain sensation is rather poor. <elvic splanchnic and vagus are also known to carry visceral pain sensations. Thus pelvic visceral pain is also carried by pelvic splanchnics.

To3ch 6en6at5on Touch sensation may be fine or crude. Touch receptors are found in the skin and include meissner0s corpuscle, pacinian corpuscle and ruffini0s organ.

/ome parts of the body are very sensitive to touch, whereas the skin of the back is relatively insensitive. Touch receptors adapt &uickly. The sense of vibration, pressure and two point discrimination are all basically tactile sensations. Thermal 6en6at5on 4old and warm receptors are nerve endings which are simply called cold receptors and warmth receptors respectively. 4old receptors are more numerous than the warmth receptors. Acold spots0 in the skin are distinct from Awarmth spots0.

CERVICAL SPONDYLOSIS
DI%%ERENTIAL DIA1NOSIS O% CERVICAL S+OND)LOSIS The diseases to be considered in differential diagnosis of cervical spondylosis are1

(A)
(1)

Other ca36e6 of 4a5n 5n the nec:

Tra3ma to the cer/5cal 645ne

Trauma to the cervical spine )fractures, subluxation* places the spinal cord at risk for compression. 3otor vehicle accidents, violent crimes, or falls account for 9%E of spinal cord in!uries, which can have devastating conse&uences. Emergency immobilization of the neck prior to complete assessment is mandatory to minimize further spinal cord in!ury from movement of unstable cervical spine segment.

(2)

Cer/5cal 956c 956ea6e

Herniation of a lower cervical disc is a common cause of neck, shoulder, and arm or hand pain. 5eck pain )worse with movement*, stiffness and limited range of neck motion are common.

8ith nerve root compression pain may radiate into a shoulder or arm. Extension and lateral rotation of the neck narrows the intervertebral foramen and may reproduce radicular symptoms.

(3)

Rhe3mato59 arthr5t56 of cer/5cal a4o4h765al ;o5nt6

@2 of cervical apophysial !oints results in neck pain, stiffness and limitation of motion. In typical cases with symmetric inflammatory polyarthritis the diagnosis of @2 is straight forward. In advanced @2 synovitis of the atlantoaxial !oint )4#+4$* may damage the transverse ligament of the atlas, producing forward displacement of the atlas on the axis )atlanto+axial subluxation*. (") In;3r7 to brach5al 4le<36 an9 ner/e6 <ain from in!ury to the brachial plexus or arm peripheral nerves can occasionally be confused with pain of cervical spine origin. 5eoplastic infiltration of the lower trunk of the brachial plexus may produce shoulder pain radiating down arm. <ost radiation fibrosis on a pancoast tumour of lung may produce similar findings.
(B)

Other ca36e6 of 6ho3l9er 4a5n

<ain in the shoulder region can be difficult to separate clearly from neck pain. The symptoms and signs of radiculopathy are absent, then the differential diagnosis includes mechanical shoulder pain )tendonitis, bursitis, rotator cuff tear, dislocation, adhesive capsulitis and cuff impingment under the acromian* and reffered pain )subdiaphragmatic irritation, angina, pancoast tumour*. 3echanical pain is often worse at night, associated with local shoulder tenderness and aggravated by abduction, internal rotation,

or extension of the arm. The pain of shoulder disease may at times radiate into the arm or hand but the sensory, motor and reflex changes that indicate disease of the nerve roots, plexus or peripheral nerve is absent.

MANAGEMENT

The symptoms of cervical spondylosis undergo spontaneous remissions and exacerbations. The treatment is aimed at assisting the natural resolution of the temporarily inflamed soft tissue. )2* =uring 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) <roper

neck

posture1

The

patient

must

avoid

situations where he has to keep his neck in one position for a long time.
(2) (3)

(nly a thin pillow should be used at night 5eck muscle exercises. These help in improving the neck

posture.
(B) =uring an episode of acute exacerbation the following treatment

is re&uired.
(1) (2) (3)

Hot fomentation @est to the neck in a cervical collar Traction to the neck if there is stiffness.

APPROACH TO THE PATIENT WITH SPINE DISORDER

2 patient with spine disorder presents either with pain usually in the cervical or lumbosacral region or with a deformity. The deformity may be a kyphosis or scoliosis. /ometimes, there may be no or minimal symptoms in the back, but are primarily in the limbs. ?pper

limb pain in cervical disorders and lower limb pain in the lower limb disorders. 2t times the presenting symptom of a patient with spine disorder is neurological deficit+ &uadriplegia, paraplegia or paraesthesia and weakness pertaining to one or more nerve roots H56tor7 ta:5n8 The following are the common presenting complaints1 )#* <ain in the neck or back. )$*@adiating pain in the upper limbs, girdle+pain along the trunk, or sciatic pain along the back or front of leg ).*<araesthesia and weakness is a part of the limb due to involvement of one or more nerve roots. )6*3ore extensive weakness of limbs, eg1 paraplegia or &uadriplegia.

H56tor7 of 4re6ent5n8 5llne66 (1) +a5n <ain is a common symptom. It is mostly non+specific but the following are the some characteristic pains indicating a specific diagnosis. )a* /harp shooting pain down the limb, which is aggravated by coughing or on minimal movements indicates a disc prolapse. )b* =ull boring pain which increases on exertion, and gets relieved on rest is due to osteoarthritis. )c* <ain in a young male, associated with stiffness, more early in the morning, which wears off as the person gets involved in daily chores, would be seronegative spond+arthritis. )d* ,ackache associated with the pain and numbness, radiating down the leg, especially on exertion, and gets relieved on rest is indicative of spinal canal stenosis. /uch a symptom is called neurological claudication.
(e)

,ack pain in the dorso+lumbar region in the young may be

due to traumatic or infective pathology. ( ) Ne3rolo85cal 67m4tom6 4omplaints such as weakness, numbness and paraesthesias are often associated with spinal disorders. /ymptoms localized to one limb usually indicate disc pathology.

,ilateral lower limb weakness and loss of sensation occurs usually in dorsal and dorso+lumbar spine diseases. 2 cauda+e&uina syndrome presentation occurs in lumbar spine diseases. 5eurological symptoms in T, spine and in tumours are gradual in onset in disc prolapse these are rather sudden.

EXAMINATION OF THE PATIENT

(1)

Exposure+ 2 proper exposure of the whole spine is crucial. 2

female patient should be asked to change and wear a gown open from the back. 2 nurse or female attendant should be present when examining a female patient. )$* <osition+ 2 patient with cervical spine disease is examined with the patient sitting on a stool so that the examiner can observe from front, side or back. 2 patient with lumbar spine or dorso+lumbar

spine disease is examined first standing, then lying supine and lying prone. The following points are noted1 )a* :ait1 (bserve the gait as the patient walks into the room.

2 side lurching gait may suggest a scoliosis. 2 patient with painful condition of the spine walks rather continuously walking with short steps and a stiff spine. 2 patient with acute disc prolapse has a forward atop and sideways tilt of the torso on the oelvis.
(b)

=eformity1 5ormally, the neck has lordosis

the dorsal

spine is kyphotic and lumbar spine lordotic. The nape of the neck is in a straight line above the natal cleft. The position of the shoulder, scapular blades, lumbar hollows and iliac wings is symmetrical. 2ny deviation could be due to disease. 2 diffuse kyphosis occurs in ankylosing spondylosis, schuermann0s disease, osteoporosis etc. 2 localized kyphosis may be very sharp due to collapse of one vertebra or localized to collapse of $+. vertebra. -oss of lumbar and cervical lordosis occurs in painful conditions of that part of the spine. /coliosis may be obvious, or may be detected on carefully comparing the symmetry of the spine as discussed above. 2 transverse deep furrow, more like a step, may be seen in the lumbosacral region in the spondylolisthesis. /welling in the paravertebral region or a little away could be due to a cold abscess prominence of one spinous process occurs in

traumatic spine. <rominence of more than two spinous processes occurs most commonly in <ott0s spine. +al4at5on The following points are noted1 )#* Tenderness1 2sk the patient to the point to the site of pain. 2 general localization of the site of disease can be made by gently hitting the spine from top to bottom with a fist. 3ore specific localization is made by pressing the spinous process with the thumb. )$* 3ovements1 The following movements of the spine are noted (a) %le<5on The patient is asked to bend forward and touch his feet. 8hile he does so, the examiner feels the movement between the spinous processes away from one another. 2lso, one should look for spasm of the erector spinae muscles on both sides of the spine when flexion is being tested. (b) S59e fle<5on The patient is asked to bend sideways and any limitation is noted. (c) Rotat5on6 The patient is asked to sit on a stool and side rotations are examined.

Ne3rolo85cal te6t5n8 2 complete neurological examination of the limb, especially if there are symptoms such as radiating pain, paraesthesia or weakness is necessary. This consists of the following1

(1) Stra58ht le8 ra565n8 te6t This test indicates nerve root compression. 8ith the patient lying on a couch, his affected leg is lifted gradually with the knee straight. 2s this is done, the patient complains of pain or stretching at the back of the thigh or in the calf. The angle at which this occurs is noted. 2 positive /-@T at 6F degrees or less is suggestive of root compression. This leg is now lowered a little till the stretching becomes less. 2t this angle if the ankle is passively dorsiflexed, the pain at the back of thigh or in the calf will again be felt. This is called reinforcement positive. /ometimes, a /-@T performed on the affected side, may give rise to pain on the affected side. This is termed a contra lateral positive /-@T and is a very specific sign of root compression, possibly by a disc prolapse. ( ) La6e83e te6t This is a modification of /-@T where first the hip is lifted to GF degrees with the knee bent. The knee is then gradually extended by the examiner. If nerve stretch is present, it will not be possible to do so and the patient will experience pain in the back of the thigh or leg.

(!) Motor 4o0er These are examined in different muscle groups of the limb especially that of EH-, ankle dorsiflexor is a case of disc prolapse. (") Sen6or7 lo66 These are examined dermatome wise, especially in -6,-7, /# dermatomes. (#) Refle<e6 The deep and superficial reflexes and ,abinski0s reflex are

examined.

General e a!"na#"$n

The following examination should be done in a case with spine disease.

(1)

-ook for cold abscesses away from the site of tuberculosis

of the spine. )$* 4hest should be examined to look for a tubercular focus

there, or to rule out an old chest disease. ).* spine. Examination of the breast, kidney, prostate, thyroid and

abdomen is necessary if a secondary is being suspected in the

MATERIAL AND METHODS

INVESTIGATIONS
<rogressive neck pain is a key indication of cervical spondylosis. It may be the only symptom in many cases. Examination often shows limited ability to flex the head to the side )bend head toward shoulder* and limited ability to rotate the head. 8eakness or sensation loss indicates damage to specific nerve roots or to the spinal cord. @eflexes are often reduced.
(1)

;+ray of cervical spine )2< and lateral* is sufficient in

most cases. The following radiological features may be present1

(a)

5arrowing

of

the

intervertebral

disc

spaces

)most

commonly between 47+4'*. )b* (steophytes at the vertebral margins, anteriorly and

posteriorly.

)c* views. )$* ).*

5arrowing

of

the

intervertebral

foramen

in

cases

presenting with radicular symptoms may be best seen on obli&ue

2 4T scan or spine 3@I confirms diagnosis. 2 myelogram )x+ray or ct scan after in!ection of dye into

the spinal column* may be recommended to clearly identified the extent of in!ury. )6*
(5)

2n E3: may also be recommended. 2n ;+ray of the lower )lumber* spine may reveal

degenerative changes in this region.

REVIEW OF HOMOEOPATHIC MEDICAL LITERATURE

MIASMATIC EVOLUTION
3iasm is an invisible, dynamic principle, which permeates into the system of a living creature, creating a groove or stigma in the constitution, which can only be eradicated by a suitable anti+ miasmatic treatment. If effective anti+miasmatic treatment does not take place then the miasm will persist throughout the life of the person and will be transmitted to the next generation. 3iasmatic dissection and incorporation of the same in each case will help )a*to open up a case, where there is a scarcity of symptoms due to various physical or emotional suppressions. )b*to be more confident in prescribing by including the surface miasm in the consideration of the totality, as miasm constitutes a ma!or part of totality)c*to evaluate the necessity of change of plan of treatment )d* to evaluate the homoeopathic prognosis of the case, as removal of layers of suppression manifest as clarity of symptoms and can be accompanied by a &uantum !ump in the sense of well being )e* anti+miasmatic medicines help to clean up the presenting symptoms from its root of origin and clear up the

susceptibility to get infection and thereby strengthens the constitution. ,asically psora is Ahypo0 in expression which gives rise to hypo+ immunity, in turn resulting in hyper+susceptibility which manifests as an exalted sensitivity to the external environment and allergens, itching, irritation and burning lead towards congestion and inflammation with only functional changes. /ycosis produces in coordination everywhere resulting in overproduction, growth and infiltration in the form of warts, condylomata, tumours, fibrous tissues etc. /yphilis produces destructive disorder everywhere which manifests as perversion, suppuration, ulceration and fissures. The tubercular miasm produces changing symptomatology, confusing vague symptomatology and conditions which are variable and contradictory.

MANAGEMENT & HOMOEOPATHIC TREATMENT

HOMOEOPATHIC APPROACH
Homoeopathy is the fingerpost on the crossroads of healing which directs the way to safest and permanent cure. It is a very effective and easy way to attain cure. Homoeopathic treatment can reward or effective cure in cases of initial period of disease. In chronic cases or late start of treatment, Homoeopathy can relieve congestion of spine and compression of nerves, if there is no fixation of bones. The treatment cannot arrest the progressive degenerative changes. In case of a badly deformed spine, it can only help with temporarily management of pain. The results of Homoeopathy in managing cervical spondylosis will be marvelous and dramatic compared to other systems of medicine or surgical intervention. (ne thing everyone should accept is that we cannot do against nature i.e. if it is due to ageing process, we have to accept it. ,ut surely, we can live better without any complaint or pain with proper posture and homoeopathic medicine likewise, structural damage in advanced cases cannot be cured completely but we can manage the condition without pain. 8e can aim for near normal in all cases. If we mask the pain with external application or pain killers, without

treating the actual condition then it will lead to complications due to use of the neck in spite of pain or complaints which have been masked. Homoeopathic spondylosis1 (A) D-RIN1 AC-TE E2ACERBATIONS medicines commonly used in case of cervical

1) Bella9onna H /tiff neck. <ain in nape, as if it would break. <ressure on dorsal region most painful. Dertigo, with falling to left side or backwards. /ensitive to least contact. 3uch throbbing and heat. <ain worse light, noise, !ar, lying down and in afternoon better by pressure and semi erect posture it is always associated with hot, red skin, flushed face, glaring eyes, throbbing carotids, excited mental state, hyperesthesia of all senses, delirium, restless sleep, convulsive movements, dryness of mouth and throat with aversion to water, neurological pains that come and go suddenly. 5o thirst, anxiety or fear. "or violence of attack and suddenness of onset. ) Arn5ca H :reat fear of being touched or approached. <ain in neck and limbs, as if bruised or beaten. /prained and dislocated feeling. /oreness after overexertion. Everything on which he lies seems too hard. Dertigo ob!ects whirl about especially suited to cases when an in!ury, however remote, seems to have caused the present trouble. 2fter traumatic in!uries, overuse of any organ,

strains. 2 muscular tonic, worse least touch, rest, damp cold, better, lying down or with head low. !) Br7on5a H<ainful stiffness in nape of neck. /titches and stiffness in small of back from sudden change of weather. Ioints red, swollen, hot with stitches and tearing worse on least exertion every spot is painful on pressure. Dertigo, nausea faintness on rising, confusion. Headache seated in occiput, worse on motion, even of eyeballs. The general character of the pain produced is stitching, tearing worse by motion better rest. ") C5mc5f38a Racemo6a = /tiffness and contraction in neck and back. /pine is very sensitive, especially upper part. @heumatic pains in muscles of back and neck. 4rick in back. 2ching in limbs and muscular soreness. ?neasy restless feeling in limbs. Heaviness in lower extremities. Heavy aching with tensive pain. Especially useful in rheumatic nervous sub!ect with ovarian irritation, uterine cramps and heavy limbs. Its muscular and crampy pains occurring in nearly every part of the body are characteristic. 2gitation and pain indicate it. #) Chel59on53m ma;36 =<ain in nape, stiff neck, head drawn to left. "ixed pain under inner and lower angle of right scapula. <ain at lower angle of left scapula. <ain in arm, shoulders, hands tips of fingers. Icy coldness of tips of fingers. Icy coldness of occiput from nape of neck feels heavy as lead. Dertigo associated with hepatic disturbance. The great general lethargy and indisposition to make any effort is also marked ailments brought on or renewed by change

of weather. 8orse, right side, motion, touch, very early in morning. ,etter from pressure. $) Colch5c3m* <ain in occiput and nape of neck, worse afternoon and evening. ,ackache better rest and pressure. /harp pain down left arm. Tearing in limbs during warm weather, stinging during cold. <ins and needles in hands and wrists, fingertips numb, pain in front of thigh. @ight plantar reflex abolished limbs lame, weak tingling, worse in evening and warm weather. Ioints stiff and feverish shifting rheumatism pains worse at night. 2ffects markedly the muscular tissues, periosteum and synovial membranes of !oints. The parts are red, hot and swollen. &) 1el6em53m* <ain in neck, especially upper sternocliedomastoid muscles. =ull, heavy pain. <ain in muscles of back, hips and lower extremities, mostly deep seated cramps in muscles of forearm. Dertigo spreading from occiput. Heaviness of head eyes bruised sensation band feeling around and occipital headache. =ull, heavy ache with heaviness of better compression and lying with head high. =izziness, drowsiness, dullness and trembling. ') >alm5a lat5fol5a* pain from neck down arm it would break is localized regions of spine in upper three

dorsal vertebrae extending to shoulder blade. <ain down neck, as if through shoulders. -umbar pains of nervous origin. <ain affects a large part of limb, or several !oints and pass through &uickly. 8eakness, numbness, pricking and sense of coldness in limbs. <ain along ulnar nerve,

index finger. Tingling and numbness of left arm, neuralgia shoot downwards, with numbness.

pains

() Lachnante6* pain in nape, as if dislocated, stiffness of neck. @heumatism of the neck. 5eck drawn over to one side. 4hilliness between the shoulder+blades pain and stiffness in back produces a desire to talk, a flow of language and the courage to make a speech. @ight sided pain in head, extending down to !aw head feels elongated worse least noise. /leepless. ,urning in palms and soles. 1?) N3< /om5ca* pain and stiffness in cervical region. ,urning in spine worse . to 6 am. 4ervico+brachial neuralgia worse touch. 3ust sit up in orde to turn in bed. ,ruised pain below scapulae. /itting is painful. 2rms and hands go to sleep. Headache in occiput with vertigo brain feels turning in a circle, oversensitiveness. <atient is thin, spare, &uick, active, nervous and irritable, leading a sedentary life, found in prolonged office work and overstudy. 8orse cold. ,etter in evening, while at rest, in damp wet weather, strong pressure. 11) Rh36 to<5co9en9ron* /tiffness of the nape of neck. <ain between shoulders on swallowing tearing pains in tendons, ligaments and fasciae. @heumatic pains spread over a large surface at nape of neck, loins and extremities better motion. The cold fresh air is not tolerated. <ain along ulnar nerve. 4rawling sensation in tips of fingers. Headache in occiput, painful to touch. Heavy head. Dertigo when rising. 3otion always Alimbers up0 the patient and hence feels better for a time from a change of position. 2ilments

from strains, over lifting, getting wet while perspiring. 8orse, during sleep, cold wet weather and after rain, rest, lying on back or right side. ,etter, warm dry weather, motion, rubbing, warm application, from stretching out limbs.

(B)
(")

D-RIN1 THE +ERIOD O% REMISSION@ Ar6en5c3m alb3m* /tiffness and pain in cervical region.

=rawing in of shoulders. <ain and burning in back. Heaviness and uneasiness in extremities. ,urning pains relieved by warmth. Headaches relieved by cold other symptoms worse. <eriodical burning pains with restlessness. Its general symptoms often alone lead to its successful application. 2mong these the all prevailing debility, exhaustion and restlessness, with nightly aggravation are most important. :reat exhaustion often the slightest exertion. "ear fright and worry. =egenerative changes. 8orse, wet weather, after midnight, from cold drinks or food, right side. ,etter from heat, from head elevated, warm drinks.
(2)

Ca36t5c3m* dull pain in nape of neck. /tiffness between

shoulders. =ull tearing pain in hands and arms. Heaviness and weakness. 5umbness loss of sensation in hands. @heumatic tearing in limbs better by warmth especially from heat of bed. 3anifests its action mainly in chronic rheumatic, arthritic and paralytic affections, indicated by tearing, drawing pains in muscular and fibrous tissues with deformities about !oints progressive loss of

muscular strength, tendinous contractures. The skin of a person is of dirty white, sallow with warts, especially on the face. Emaciation due to disease, worry etc and of long standing. ,urning rawness and soreness are characteristic.
($)

Con53m* pain between shoulders. Ill effects of bruises and

shocks to spine. Extremities heavy, weary, paralysed fingers and toes numb. 3uscle weakness, especially of lower limbs. <erspiration of hands. <utting feet on chair relieves pain. Dertigo, when lying down and when turning over in bed, when turning head sidewise or turning eyes worse shaking head, slight noise or conversation of others, especially towards the left. =ull occipital pain on rising in morning. Troubles at change of life. (ld maids and bachelors. 8eakness of body and mind, trembling and palpitation. 8orse before and during menses, from taking cold, bodily or mental exertion, celibacy. ,etter while fasting, in the dark, from letting limbs hang down, motion and pressure.
(!)

%err3m

metal5c3m*

@heumatic

pain

in

left

arm

and

shoulder. -umbago

better, slow walking. <ain in hip !oint, tibia,

soles and heel. <ain in back of head, with roaring in neck. Dertigo in seeing flowing water. ,est adapted to young, weak persons, anaemic and chlorotic, with pseudo+plethora who flush easily cold extremities over sensitiveness worse after any effort. 8eakness from mere speaking or walking through looking strong pallor of skin, mucous membranes, face alternating with flushes. ,etter walking, slowly about. ,etter, after rising. 8orse while sweating while

sitting

still.

2fter

cold

washing

and

overheating.

3idnight

aggravation.
(%)

1ra4h5te6* <ain in nape of neck shoulders and back and

limbs. /pinal pains. -eft hand numb arms feel asleep. <atients, who are rather stout, of fair complexion with tendency to skin affections and constipation, fat chilly and costive, with delayed menstrual history. Take cold easily. Has a particular tendency to develop the skin phase of internal disorders. 2nemia with redness of face. Tendency to obesity. Timid, indecisive, music makes her weep, worse warmth, at night, during and after menstruation. ,etter, in the dark, from wrapping up.
( )

Lac can5n3m* rheumatic pains in the extremities and back,

from one side to the other. <ain in arms to fingers. <ain and stiffness in neck. ,urning in palms and soles. /ensation of walking or floating in the air. Headache. "irst one side, then the other. (ccipital pain with shooting extending to forehead. The keynote symptom is erratic pains, alternating sides. "eels as if walking on air or of not touching the bed when lying down great weakness and prostration. =espondent, visions of snakes. =reams of snakes. 8orse, morning of one day and in the evening of next. ,etter, cold, cold drinks.
(&)

Lache656* <ain in neck. 8orse cervical region. /ensation of

threads stretched from back to arms, legs, eyes. /ensation of tension in various parts. 4annot bear anything tight anywhere. <ain through head on awakening. <ressure and burning on vertex with

headache, flickering, dim vision, very pale face. Dertigo relieved by onset of discharge. :reat lo&uacity. Iealous, suspicious. 8orse after sleep, left side, in the spring, warm bath, pressure or constriction, hot drinks, closing eyes. ,etter appearance of discharges, warm application.
(')

L7co4o953m*

<ain

and stiffness

in

the neck.

,urning

between scapulae as of hot coals. 5umbness also, drawing and tearing in limbs especially while at rest or at night. Heaviness of arms tearing of shoulder and elbow !oints. -imbs go to sleep. /hakes head without apparent cause. Tearing pain in occiput, better fresh air. Dertigo in morning on rising. In nearly all cases where -ycopodium is the remedy, some evidence of urinary or digestive disturbances will be found. 3elancholic, afraid to be alone. -oss of self confidence. 2pprehensive. 8eak memory, confused thoughts, worse right side, from right to left, from above downwards, 6+9 pm from heat or warm room. 8arm applications except throat and stomach which are better from warm drinks. ,etter by motion, after midnight, from warm drink, on getting cold, from being uncovered.
(()

Me9orrh5n3m* stiffness in neck region. <ain in back, with

burning heat. ,urning of hands and feet. @estless, better clutching hands. -egs heavy ache all night cannot keep them still. Heels and balls of feet tender. Head heavy and drawn backward. ,urning pain in brain, worse occiput. Headache from !arring of cars, exhaustion or hardwork. 4hronic ailments due to suppressed gonorrhea. :reat disturbance and irritability of nervous system. <ains intolerable,

tensive and nerves &uiver and tingle. History of sycosis worse when thinking of ailment, from day to sunset, heat. ,etter at seashore, lying on stomach, damp weather.
("0)

+3l6at5lla* shooting pain in the nape of neck and back in the sacrum after sitting. <ain in limbs, tensive pain, letting up with a snap. 5umbness

between shoulders shifting rapidly

around elbow. Deins in forearm and hands swollen. -egs feel heavy and weary. Dertigo, better in open air. 5euralgic pains, commencing in night, temporal region with scalding lachrymation of affected side. The disposition and mental state are chief guiding symptoms. It is pre+eminently a female remedy, especially for mild, gentle, yielding disposition. 8orse from heat. ,etter, open air, cold applications.
("")

S3l4h3r*

/tiffness

of

nape.

=rawing

pains

between

shoulders. /ensation as if vertebrae glided over each other. Trembling of hands. @heumatic pains in left shoulder. ,urning in soles and hands at night. /toop shouldered. 4onstant heat on top of head. Heaviness and fullness. ,eating headache worse stooping and with vertigo. /tanding is the worst position for sulphur patient. Ebullitions of heat, dislike of water, dry and hard hair and skin, red orifices, sinking feeling at stomach about ## am and cat+nap sleep always indicate sulphur homoeopathically.

AUXILIARY TREATMENT

+H)SIOTHERA+) The goal of physiotherapy treatment is to relieve pain, and enhance movements of the neck. Short0a/e 95atherm7 + 2 disc or heating pad is placed over the back of the neck. The warmth obtained from the shortwave diathermy current relaxes the muscle and the pain is relieved. Cer/5cal Tract5on + Traction is a mechanical device, which supports the head and chin. It is used to relieve the nerve compression by a bone. +o6t3re correct5on + /imple postural exercises can be taught to correct the faulty position of the neck. 3otivation is given to maintain the erect posture1 Collar6 + Two types of collars can be prescribed1 #./oft 4ollar + /oft collar is used during night times to prevent awkward position of the neck during sleep. $."irm 4ollar + "irm collar steadies the neck and relieve pain, especially during traveling or work. It is removed when the pain subsides.

RELA2ATION @elaxation is essential part of treatment. Tension in neck and shoulder muscle, pain, anxiety is all relieved by relaxation. @elaxation can be done in two ways1 2* <hysical @elaxation. ,* 3ental @elaxation.

A) +H)SICAL RELA2ATION. The whole body is relaxed by free suitable and comfortable positions, so that the muscles are freed from tension and the pain is relieved. "or e.g., position of relaxation + when you are lying flat on your back. #. (ne pillow under the head $. (ne cushion for the shoulder and .. (ne under knees. The pillow should be firm and thin. This position will allow relaxation for your body while lying down. @elaxation while sitting. #. The head, neck and shoulder are supported by high backed chair, with a small pillow at lower back. $. "eet supported on stool or low bench. .. 2rm, resting on arm of chair or pillow.

B) MENTAL RELA2ATION <ositive thinking and using imagination is the way of relaxing mentally. This type makes one feel better and breaks the pain cycle. 3uscle tension, anxiety, loss of sleep and pain are all relieved by mental relaxation exercises like yoga. LI%EST)LE MODI%ICATIONS /ome modifications in life style will help in over coming problems of cervical spondylosis. "or example1+ #. 2void any strain of neck and shoulder like reading and writing for long hours. $. 2void the use of very soft cushion bed and avoid using a very high pillow. ER1ONOMICS Ergonomics concentrates on the architectural design of furnitures like desk, chairs, tables etc. The design of the furniture should be such that it should support the body structure without causing any undue strain to the muscles of the back and neck.

DOAS AND DONTAS If you are prone to cervical spondylosis, 2void bad roads, if

travelling by two or four wheelers #. =o not sit for prolonged period of time in stressful postures $. =o use firm collars while traveling .. =o not lift heavy weights on head or back 6. =o not turn from your body but turn your body moving your feet first 7. =o turn to one side while getting up from lying down '. =o the exercises prescribed regularly %. =o use firm mattress, thin pillow or butterfly shaped pillow 9. =o not lie flat on your stomach.

CASE FORMATION
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CLINICAL HISTOR) 4HIE" 4(3<-2I5T/

HI/T(@K (" <@E/E5T I--5E//

<2/T I--5E//

<E@/(52- HI/T(@K

%AMIL) HISTOR) "2THE@ 3(THE@ ,@(THE@ /I/TE@ 8LH (THE@/ /(4I2- /T2T?/ =ITETI4 H2,IT/ +H)SICAL E2AMINATION 1ENERAL E2AMINATION 2<<E2@254E 5?T@ITI(52- /T2T?/ 252E3I2 <?-/E ,.<. @E/<I@2TI(5 TE3<E@2T?@E ,?I-= HK=@2TI(5 (,DI(?/ "(42- /E</I/ TEETH>:?3/ T(5/IE2@ /BI5

LOCAL E2AMINATION S)STEMIC E2AMINATION @E/<I@2T(@K /K/TE3 4.D./. 4.5./. 1ENERAL S)M+TOMS <HK/I42- :E5E@2-/

2<<+ THI@/T+ @E24TI(5 T( H>4+ /T((-+ 3E5/T@?2TI(5+ MENTAL 1ENERALS BILL -(DE H2TE "E2@ 25:E@ TE3<E@.

=>2+ /-EE<+ =@E23/+ ?@I5E+

-NDERSTANDIN1

INTELLECT TH(?:HT I--?/I(5 H2--?4I52TI(5 =E-?/I(5/ 3E3(@K

INVESTI1ATION RO-TINE INVESTI1ATION

S+ECIAL INVESTI1ATION

EVAL-ATION O% S)M+TOMS C R-BRIC %ORMATION

CONS-LTATION O% RE+ERTOR)

%INAL +RESCRI+TION

+RO1RESS RE+ORT =2TE <@(:@E// T@E2T3E5T

GRAPHS

+re,alen-e $4 -er,"-al .+$n05l$.".

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+re,alan-e

(% '% &% % *.# /#r &n0 /#r a3e 1r0 /#r '#2 /#r

+REVALENCE O% CERVICAL S+OND)LOSIS

SYNOPSIS OF CASES
CASE NO.*1 3rs. 3an!u, 67>">H, complaining of pain and stiffness in neck since $ years. <atient is chilly, sympathetic in nature and also suffers from involuntary urination while coughing. /tiffness in between shoulders M dull pain in nape of neck, especially aggravated in clear fine weather M N in wet weather. (n the basis of general symptoms, constitutional medicine 4austicum #3 >. doses was prescribed. 2fter #7 days, patient came back with great improvement. /was given M finally the patient was cured. CASE NO. 3r. I. <. singh, 7#>3>H, complaining of pain and stiffness of neck since # month with occipital headache and vertigo with dullness and drowsiness. Excessive trembling M weakness of limbs. N "rom bending forward M continued motion. (n the therapeutic basis :elsemium .F>T=/ was prescribed for % days. 2gain on futher follow up /- was given after a marked improvement, the case was cured.

CASE NO.! 3rs. /unita, .9>">H, complaining of stiffness in neck since # year. /he also had !oint pains which were constantly shifting position from one side to another. O Heat and N cold with history of recurrent tonsillitis. (n the basis of mental and physical general symptoms -ac 4an #3> . doses and /- T=/ for % days was prescribed. (n further follow up -ac 4an #3>. dose was given M after that patient was completely cured. CASE NO. " 3rs. Bumud chauhan, 77>">H, complaining of pain in right arm and shoulder since $ months worse from motion and at night. 2lso right sided headache since her menopause. ,urning in palms M soles, circumscribed red spots over malar bone. (n the basis of particular symptoms /anguinaria .F T=/ for % days was prescribed. (n further follow up /anguinaria $FF > . dose with /- was given for % days and in next follow up patient came back with almost complete cure. dreams of snakes.4omplaints are associated with burning in palms M soles

CASE NO. # 3rs. <oo!a kumari, 6F>">H, complaining of stiffness in neck since . years contracted feeling in neck and rheumatic pains in muscles of back M neck. <ain in lumbar M sacral region down thighs, !erking of limbs M heaviness in lower limbs. 8orse in cold weather and during menses and better from warmth. (n the basis of particular symptoms and modalities, 4imcifuga .F T=/ for % days was prescribed. (n further follow up 4imcifuga .F>T=/ for % days was repeated, patient came back with much improvement. 2fter that 4imcifuga $FF>. dose was given M patient was completely cured. CASE NO. $ 3r. Dikram, $9>3>H, complaining of stiffness of neck since #7 days worse after prolonged office work also disordered stomach and fre&uent and ineffectual urging for stool. Headache in occiput region with vertigo as if turning in a circle, sitting is very painful. (n the therapeutic basis 5ux vom .F T=/ for % days was prescribed. <atient came back with improvement, again 5ux vom .F was repeated M he was completely cured. CASE NO. & 3r. 2hmad, .$>3>3, complaining of soreness and stiffness of neck and back since $ months worse rainy weather and better

warmth, arm can not be moved because of pain also dread of storm. (n the therapeutic basis @hododendron .F T=/ for % days was prescribed. (n further follow up @hododendron .F>T=/ for % days was repeated, patient came back with much improvement. 2fter that @hododendron $FF>. dose was given M patient was completely cured. CASE NO. ' 3rs. @ukhsana, .7>">3, complaining of pain and stiffness of neck since 7 years, spine sensitive to touch, burning feet, desire for oranges, weak memory and weeping tendency. <ain in back, legs heavy ache all night, even can not keep them still, very restless. (n the basis of general and particular symptoms 3edorrhinum #3> .doses and /- T=/ for % days was prescribed. 2gain on futher follow up /- was given after a marked improvement, the case was cured. CASE NO. ( 3r. @a!aram, '$>3>H, complaining of pain in neck and left shoulder since ' months, worse after sleep, neck sensitive to touch, hot patient, trembling of tongue and great lo&uacity. O rising from sitting posture M must sit perfectly still. /ensation of threads stretched from back to arms, legs etc.

(n constitutional basis -achesis $FF> . doses and /days was prescribed.

T=/ for %

(n further follow up -achesis $FF > . dose with /- was given for % days and in next follow up patient came back with almost complete cure. CASE NO. 1? 3r. Ianki prasad, 7#>3>H, complaining of pain in neck and back since $ years, great sensitiveness to touch, had an in!ury $ years back since then had this complaint./ore, lame ,bruised feeling in back,everything seems too hard. (n therapeutic basis considering history of in!ury 2rnica $FF T=/ for % days was prescribed. (n further follow up 2rnica #3>. doses was given M after that patient was completely cured. CASE NO. 11 3rs "arzana Bhan, 6%>" >3, complaining of stiffness of the nape of neck. <ain between shoulders on swallowing tearing pains in tendons, ligaments and fasciae. @heumatic pains spread over a large surface at nape of neck, loins and extremities better motion. The cold fresh air is not tolerated. (n therapeutic grounds @hus Tox $FF>. dose for % days was given.

(n further follow up -achesis $FF > . dose with /- was given for % days and in next follow up patient came back with almost complete cure. CASE NO. 1 3r Dikas singh '9>3>H, complaining of stiff neck. <ain in nape, as if it would break. <ressure on dorsal region most painful. Dertigo, with falling to left side or backwards. /ensitive to least contact. 3uch throbbing and heat. <ain worse light, noise, !ar, lying down and in afternoon better by pressure. (n the therapeutic grounds ,elladonna .F>T=/ for % days was given. (n further follow up ,elladonna .F>T=/ for % days was repeated, patient came back with much improvement. 2fter that ,elladonna $FF>. dose was given M patient was completely cured. CASE NO. 1! 3r 2shok @awat 6F>3>H, complaining of painful stiffness in nape of neck. /titches and stiffness in small of back from sudden change of weather. Ioints red, swollen, hot with stitches and tearing worse on least exertion every spot is painful on pressure. (n the therapeutic grounds ,ryonia .F>T=/ for % days was prescribed. <atient came back with improvement, again ,ryonia .F was repeated M he was completely cured.

CASE NO. 1" 3rs :eeta, .9>">H, complaining of stiffness in neck since # year. /he also had !oint pains which were constantly shifting position from one side to another. O Heat and N cold with history of recurrent tonsillitis. (n the basis of mental and physical general symptoms -ac 4an #3> . doses and /- T=/ for % days was prescribed. (n further follow up -ac 4an #3>. doses was given M after that patient was completely cured. CASE NO. 1# 3rs. @an!ana kumari, 6F>">H, complaining of stiffness in neck since . years contracted feeling in neck and rheumatic pains in muscles of back M neck. <ain in lumbar M sacral region down thighs, !erking of limbs M heaviness in lower limbs. worse in cold weather and during menses and better from warmth. (n the basis of particular symptoms and modalities, 4imcifuga .F T=/ for % days was prescribed. (n further follow up 4imcifuga .F>T=/ for % days was repeated, patient came back with much improvement. 2fter that 4imcifuga $FF>. dose was given M patient was completely cured. dreams of snakes.4omplaints are associated with burning in palms M soles

CASE NO.*1$ 3rs @itu :aur 7#>">H, complaining of pain in occiput and nape of neck, worse afternoon and evening. ,ackache better rest and pressure. /harp pain down left arm. Tearing in limbs during warm weather, stinging during cold. <ins and needles in hands and wrists, fingertips numb, pain in front of thigh. (n therapeutic grounds 4olchicum .F>T=/ for % days was prescribed. (n further follow up 4olchicum .F>T=/ for % days was repeated, patient came back with much improvement. 2fter that 4olchicum $FF>. dose was given M patient was completely cured. CASE NO. 1& 3rs. @ehana, .7>">3, complaining of pain and stiffness of neck since 7 years, spine sensitive to touch, burning feet, desire for oranges, weak memory and weeping tendency. <ain in back, legs heavy ache all night, even can not keep them still, very restless. (n the basis of general and particular symptoms 3edorrhinum #3> .doses and /- T=/ for % days was prescribed. 2gain on futher follow up /- was given after a marked improvement, the case was cured. CASE NO. 1' 3rs. 3alti shah, 67>">H, complaining of pain and stiffness in neck since $ years. <atient is chilly, sympathetic in nature and also

suffers from involuntary urination while coughing. /tiffness in between shoulders M dull pain in nape of neck, especially aggravated in clear fine weather M N in wet weather. (n the basis of general symptoms, constitutional medicine 4austicum #3 >. doses was prescribed. 2fter #7 days, patient came back with great improvement. /was given M finally the patient was cured. CASE NO. 1( 3r 2nand $9>3>H complaining of rheumatic pain in left arm and shoulder. -umbago better, slow walking. <ain in hip !oint, tibia, soles and heel. <ain in back of head, with roaring in neck. Dertigo in seeing flowing water. (n the therapeutic grounds "errum 3et $FF>. dose with /- for # week was prescribed. (n further follow up "errum 3et $FF > . dose with /- was given for % days and in next follow up patient came back with almost complete cure. CASE NO. ?

3r 2rchana <uran /ingh '9>3>H, complaining of stiff neck. <ain in nape, as if it would break. <ressure on dorsal region most painful. Dertigo, with falling to left side or backwards. /ensitive to least contact. 3uch throbbing and heat. <ain worse light, noise, !ar, lying down and in afternoon better by pressure.

(n the therapeutic grounds ,elladonna .F>T=/ for % days was given. (n further follow up ,elladonna .F>T=/ for % days was repeated, patient came back with much improvement. 2fter that ,elladonna $FF>. dose was given M patient was completely cured.

BIBLIOGRAPHY

#. #. $. .. 6. 7.
6. 7. 8. 9. 10. 11. 12. 13.

4ombined medical diagnostic treatment

Harrison0s practice of medicine @obbins pathology 2natomy of , = 4haurasia Tortora0s anatomy and physiology :uyton0s physiology Bent0s materia medica ,oericke0s materia medica (rganon of medicine "arrington0s materia medica =ubey0s materia medica 4larke0s materia medica <hatak0s materia medica <hysiotherapy text book