Volume 12, Number 3 | Fall 2017

Clinical Report (Acupuncture)
The Effect of Acupuncture and Moxibustion for
Ossification of Posterior Longitudinal Ligament andCervical Spondylotic Myelopathy

acupuncture treatment with minimal stimulation.
During treatment in prone position, the pain
worsened, so Zhu’s scalp acupuncture was appliedsitting down, and the pain subsided somewhat. Scalp

Kiyoi Hirano

acupuncture was applied to the front 2/3 of the zone

Fukuoka School of Health Sciencefrom the top of the right side of the head to thetemple, corresponding to the upper left limb, and to1. Introduction

the front 1/4 of the area from the temple to the top of

Ossification of posterior longitudinal ligament

thehead,correspondingtothehead(OPLL) is a progressive disease in which the(cerebral/neurological), with the aim of relieving theossification of the longitudinal ligament locatedpain.

posterior to the vertebra oppresses the spinal cord intransmitting moxa using moxa paper was applied tothe spinal canal and causes such symptoms as

the area 2cm outside the spinous process of segmentsswelling and pain that eventually spreads over aC3 to C5 and to the LU-3 point on the left side usinglarger area.1) In this study, patients of OPLL whomoxa paper. After applying the moxa five times, thesuffered from intense pain that could not be

patient’s symptoms disappeared. (Second visit) Four

alleviated with an analgesic and were recommended

days later. The patient visited the clinic aftertoacupuncture

experiencing intense pain from early morning.

treatment to relieve the pain. Favorable results wereElectric acupuncture was applied to the same points

obtained as presented below. Additionally, whenas the scalp acupuncture for 10 minutes at 1Hz,

acupuncture treatment was similarly provided to

φ0.16mm needles were inserted in the area outside

two patients of cervical spondylotic myelopathy, thethe spinous process of segments C5 and C6 on thetreatment was effective in one patient but non-left side to a depth of about 2cm and embedded there,effective in the other, as also discussed below.

and half rice grain size moxa was applied five times

undergosurgery,

weregiven

Additionally,

half

ricegrain

sizeheatto the outside of the spinous process of segments C3
2. Cases

to C7 on the left side and the BL42 point on the left

[Case 1] 62-year-old maleside using moxa paper. As a result, the patient’s[Chief complaint] Intense pain from the posterior

symptoms

region of the neck on the left side to the shoulder

treatment was applied once a week, and by thearea and lateral surface of the arm due to OPLL.

seventh visit, the patient recovered to the point

Taking an analgesic induced a sleep disorder.

where he could carry on with this daily life without[History of present illness] The patient developed theany problem, so the frequency of the treatment wassymptoms in January YYYY. In February YYYY, hereduced to once a month, and he was treated only

was told he has continuous ossification fromwithsegments C3 to C4, with the ossification (protrusion)

moxibustion. Scalp acupuncture was rarely applied,occupying one-third of segment C3 at the most. He

thinking that the disappearance of the initial pain

was therefore recommended to undergo surgery. The

might have been attributed to the change in posture

pain was most intense when the patient drove his car,from prone position to sitting position. Figure 1

lay down, or walked, such that he took an increasingshows the acupuncture points used from theamount of analgesics.

patient’s fourth visit and on. In all cases, the needles[Progress of treatment] (First visit) May YYYY. The

were inserted to a depth of about 2cm. (15th visit)patient had a fear of needles and requested

February YYYY+1. The pain remained gone, and the8ofpain

embedding

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

disappeared.

needles

Thereafter,

acupunctureandVolume 12, Number 3 | Fall 2017

patient was able to carry on with his daily life
without any problem, but CT images did not show
any decline in ossification. (23rd visit) September
YYYY+1.

Thepainreturned,butelectricacupuncture to the posterior region of the neckdissipated the pain. (39th visit) February YYYY+3.
The patient experienced no pain for more than a year,
so treatment was canceled. Thereafter, the pain
returned in June YYYY+3, however, so treatment
was resumed once every one to two months. Figure 2
shows a CT image taken in August YYYY+3. Avertical spreading of the ossification could be seen,
but it was not accompanied by pain. The patient
continues to receive treatment today.

Figure 2 Case 1, CT image:
Vertical progression of ossification
39 months after first visit[Case 2] 57-year-old male

Th1

C7

C6

C4

C3

[Chief complaint] Numbness of hands and fingers on
the palm side, pain and limited rotation of the neckand shoulders, weak feeling in both legs
[History of present illness] The cervical vertebra had
been secured with a bolt, but the patient continuedto feel numbness in his hands and fingers, weakness
in his legs, an itchiness in his legs, and pain in hislower back. Figure 3 shows a CT image taken on hisFigure 1

Case 1, acupuncture treatment after

4th visit:
2cm & 7cm outside the spinous process

first visit (after surgery). A disc protrusion was seen.
[Progress of treatment] (First visit) June YYYY.
Electric acupuncture was applied by inserting
needles (φ0.25mm) to the area 2cm outside thespinous process from C6 to Th2 on both the left andright sides and to the BL52 and BL25 points to adepth of about 3cm. (3rd visit) To relieve thenumbness in the hands and fingers, sleep apnea
syndrome, and associated chronic sinusitis, half ricegrain size heat transmitting moxa was additionally

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 12, Number 3 | Fall 2017

applied five times to the area 2cm outside thethis time, an improvement was also seen in thespinous process of segments C6 to Th2 on both themovement of the fingers and hands during cold times

left and right sides and to the BL43 and SL14 points.

and the numbness of the fingers and hands on thepalm side. Furthermore, the itchiness in both lower
limbs and weakness in the legs also disappeared forthe most part. (37th visit) October YYYY+2. Morethan a month without treatment caused tension in

Spinal fusion
Vertebral arch
angioplasty
Laminectomy

the neck and an abnormal noise. Nasal congestion
also worsened. The patient thus continues to receive
treatment today.

irregulery line
Figure 3 Case 2, post-operative CT image (atthe time of first visit)(12th visit) October YYYY. φ0.35mm Chinese
acupuncture needles were inserted to a depth ofabout 2cm in an area 2cm outside the spinous

Figure 4 Case 2, X-ray image after two months

process of segments C6 to Th2 on the left and rightof treatment:sides, and in SL11, SL12, LL11, GB12, BL10 and

Conspicuous misalignment of the vertebral body

EM13. There was no limitation on the rotation of theneck. Thereafter, the same treatment was continued
roughly once a month. Figure 4 shows an X-ray
image

takentwomonths

aftercommencing

treatment. After the 34th treatment two years andtwo months after the first treatment, the X-ray
image shown in Figure 5 indicated that thealignment of the neck joint was corrected. Around10

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 12, Number 3 | Fall 2017

Figure 5 Case 2, 2 months after commencing
treatment:
The vertebral body is aligned[Case 3] 71-year-old male
[Chief complaint] Heaviness in the neck, numbness
in the left hand, walking difficulty after receiving
surgery for cervical spondylotic myelopathy[History of present illness] The patient receivedsurgery to secure the cervical vertebra with a bolt in
September YYYY-3 and March YYYY-1. The pain in
his neck subsided, but the heaviness remained. He
complained of a numbness in his left hand andfingers and walking difficulty accompanying aweakness and instability of his lower body. Because
the walking difficult occurred after the surgery, thepatient became depressed and could not get himself
to go outdoors. No vertebral arch was seen insegments C3 to C6, and the vertebral body from C2
to C6 was fixed. Figure 6 shows a CT image taken
after the first surgery (October YYYY-1). Due to thesurgery, an area 7cm long and 5cm wide in the neckwas gouged and hardened. At the time of his visit tothe clinic, the patient’s walking appeared to beconsistent with the walking speed of people his age,
but he said his walking has become much slower
than before. He could not lie down in supine position.

Figure 6 Case 3, CT image after first surgery:
The muscle is largely gouged[Progress of treatment] (First visit) October YYYY.
The patient had no experience in acupuncturetreatment.

Jakutaku(needlereciprocating)acupuncture was applied to the SI8, PC6 and LI11
points on the left side in a manner that would
resonate to the hand and fingers, before embedding
them according to the embedding needles method.
Additionally, φ0.16mm needles were inserted to adepth of about 1cm in an area outside the surgicalscar on the neck and in an area 2cm outside thespinous process of segments C4 to Th1 on the left andright sides, and the needles were left there for 10
minutes according to the embedding needles. Halfrice grain size moxa were also applied ten times tothose points using moxa paper. (3rd visit) October
YYYY. There were no changes in the patient’s
symptoms, so Zhu’s scalp acupuncture was applied.
Needle stimulation was applied to the upper 1/3 and2/3 of the top of the head toward the temple on both

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 12, Number 3 | Fall 2017

the left and right sides, and the needles were left

patient, an improvement was seen in his symptoms

there for 15 minutes according to the embedding

and in the alignment of his neck after two years ofneedles. (5th visit) November YYYY. Electrictreatment. It is thus thought that the amount ofacupuncture was applied to the upper left limb for 15

stimulation influences the amount of time until anminutes at 70Hz. No changes were seen in theimprovement is seen in the symptoms.

patient’s symptoms, and the treatment was canceled

Next is an observation on moxibustion. In thisstudy, moxibustion was applied in all three cases. In

8 months later on the patient’s 23rd visit.

Cases 1 and 3, heat transmitting moxa was applied
using moxa paper, and in Case 2, heat transmitting[Result and observations]
In Case 1, ossification of posterior longitudinalmoxa was applied without using moxa paper. Heatligament (OPLL) was addressed by applying needle

transmitting moxa is becoming rather outdated instimulation to a depth of approximately 2cm andJapan. It is rarely applied or hardly known in China

electric acupuncture was applied several times to antoday. I have used heat transmitting moxa to treat

area near the afflicted area, with the result that theallergies,

pain that was so intense as to keep the patient

hemiplegia, with results that indicate its efficacy.3) 4)

awake at night disappeared. CT images clearly show5) Therefore, it was also used in the three cases of thisa progression of ossification, so careful follow-up is

study, but because acupuncture and moxibustionnecessary, and there is no telling when thewere applied at the same time, it cannot be said thatsymptoms

sincemoxibustion was effective judging from these threeacupuncture and moxibustion treatment clearlycases alone. In Case 1, the patient was nervous andbrought about a remission of the symptoms, there is

was prone to feel intense pain because he had a fear

room to consider the continuation of conservativeof needles, so there were times when it was

treatment

impossible

mightbyworsen.

acupuncture

Nevertheless,andmoxibustion.

colds,

tosleep

insertapnea

anysyndromeneedlesandandonly

Additionally, as it has been confirmed that aacupuncture was applied. As he is still undergoingrecurrence of the pain will occur if acupuncture

treatment, I would like to attempt treatment solely

treatment is suspended, it could be said thatby acupuncture hereafter.

acupuncture treatment can prevent pain caused byLastly, with regard to Zhu’s scalp acupuncture, IOPLL. In this case, the patient had a fear of needles,

have felt its efficacy against the aftereffects of aso needle stimulation was applied to an extremely

stroke and also against general pain.3) I therefore

small number of places. In other words, weak

performed scalp acupuncture in Cases 1 and 3, but

stimulation was enough to produce a sufficient effect.

when considering that in Case 1 the pain may have

In Case 2, needle stimulation and moxibustion

disappeared owing to a change in body position, it

was applied to an area 2cm outside the spinous

was performed only five times among a total of 46

process of the afflicted part of the cervical vertebra,

treatment sessions. Furthermore, in Case 2, certain

as in Case 1, but for greater effect, φ0.35mm Chinese

effects were produced without applying scalp

needles that are twice the thickness of those used inacupuncture, and in Case 3, scalp acupuncture wasCase 1 were used, and heat transmitting moxa wasapplied nine times out of a total 23 treatment

applied without using moxa cautery or moxa paper.

sessions, but no changes in symptoms were observed.

As the patient’s symptoms were in his four limbs,

Thus, the efficacy of Zhu’s scalp acupuncture is notacupuncture and moxibustion were applied to both

known in these three cases.

his left and right sides. The same acupuncture points
were used, but with greater stimulation. In this12The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 12, Number 3 | Fall 2017

[References][Conclusion]
Applying acupuncture and moxibustion treatment

1) Shoichi Kokubu, Takehiko Torisu, comp. Hyojun

to the area afflicted with ossification of posterior

seikeigeka kagaku. Tokyo. Igaku-Shoin. 2010.

longitudinal

ligament

improvement

inthe(OPLL)

broughtansymptoms

thereof,andsuspending the treatment brought a recurrence ofthesymptoms.

Thissuggested that

applying

2) Zhu Ming Qing. Zhu’s Scalp Acupuncture. Tokyo.
Toyo Gakujutsu Shuppansha. 1995.
3) Kiyoi Hirano. The Journal of Japan Traditional
Acupuncture & Moxibustion Society. Vol. 37

acupuncture and moxibustion to the afflicted area

No. 2. Tokyo. Japan Traditional Acupuncture &may have some form of impact on the spinal canal.

Moxibustion Society. 2010.

The efficacy of the same acupuncture and4) Kiyoi Hirano. The Journal of Japan Traditional

moxibustion treatment against the postoperative

Acupuncture & Moxibustion Society. Vol. 39

aftereffects of cervical spondylotic myelopathy wasNo. 2. Tokyo. Japan Traditional Acupuncture &also suggested. It is thought that with respect toMoxibustion Society. 2012.

patients who have a cervical problem, acupuncture5) Kiyoi Hirano. The Journal of Japan Traditionaland moxibustion treatment to the afflicted area hasAcupuncture & Moxibustion Society. Vol. 40

the effect of correcting the cervical alignment andNo. 1. Tokyo. Japan Traditional Acupuncture &improving the symptoms, but in cases where aMoxibustion Society. 2013.

significant decrease in muscle has occurred in the6) Miwa Nakajima, Motohiro Inoue, Megumi Itoi,afflicted part, acupuncture and moxibustion does not

Hiroshi Kitakoji. The Journal of the Japanese

have the effect of correcting the alignment.

Society of Balneology, Climatology and PhysicalBased on the above, it could be said that it isbeneficial

torecommend

acupunctureandmoxibustion treatment before surgery as long as
time allows.

Medicine, Vol. 76 No. 2. Japanese Society ofBalneology, Climatology and Physical Medicine.
2013.
(The above references 1 to 6 are all in Japanese only)

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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