HOMOEOPATHIC MANAGEMENT OF AN ACUTE CASE OF CERVICAL SPONDYLOSIS: A CASE REPORT

HOMOEOPATHIC MANAGEMENT OF AN ACUTE CASE OF CERVICAL SPONDYLOSIS: A CASE REPORT

R. B. Kulkarni, P. S. Aphale * and D. B. Sharma

Department of Homoeopathic Pharmacy, Dr. D.Y. Patil Homoeopathic Medical College & Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India.

ABSTRACT: Introduction: Cervical spondylosis is a degenerative spine disorder commonly affecting the vertebrae and intervertebral discs in the cervical region. Most people commonly present with the complaint of neck pain at least once in their lifetime. It is, therefore, important to ascertain the cause responsible for it. Homoeopathy has a great scope in relieving the pain caused due to spondylosis, thereby preventing the further progress of the disease pathology caused by this disorder. This case was undertaken to assess the efficacy of homoeopathic medicine for managing cervical spondylosis. Case Summary: A 58 years old female complained of neck pain, tingling and numbness with burning over right upper limb for the past 15-20 days. She also complained of headache on and off. No history of vertigo, giddiness was noted. No history of any other major illness was found during the interview. On detailed analysis and repertorization of the case, the homoeopathic medicine Rhus toxicodendron was given. This case was successfully treated with the selected homoeopathic medicine and auxiliary measures, and further complications were prevented. Further studies can be undertaken to assess homeopathy's effectiveness in managing cervical spondylosis.

Keywords: Case report, Cervical spondylosis, Homoeopathy, Neck pain

INTRODUCTION: Cervical Spondylosis, also called as arthritis of the neck, is a degenerative disorder of the cervical spine commonly occurring due to the collapse of the intervertebral disc space ¹. Degenerative changes can occur at solitary disc space levels in 15-40% of patients and at multiple levels in 60-85%. The discs between C3-C7 vertebrae are most commonly affected. There can be compression of the nerve roots; which can cause severe neck pain, upper limb pain and motor disturbances along the course of the affected nerve ^{2, 3}.

In 10% of individuals, spondylosis occurs due to congenital bone anomalies, blocked vertebrae, and malformed laminae. Other causes are aging and those involved in heavy physical activity like lifting weights, any past spinal surgery, severe arthritis, and ruptured or slipped disc ^{4, 5}.

The most common presenting complaint is neck pain. Neck pain presents as a major disability and hampers the patients' quality of life. They appear stressed and face problems in one or more sectors of life i.e. personal, family, work. There appears to be some role of stress and maladaptive behavior in the genesis, maintenance and progression of cervical spondylosis. Other symptoms are neck stiffness that gets worse over time, numbness or abnormal sensations in the shoulders, arms, or legs (in rare cases), headache, especially in the back of the head ^{6, 7}.

Less common symptoms are loss of balance and control over the bladder or bowel if there is pressure over the spinal cord. The conservational line of treatment consists of spinal injections or use of traction for alleviating the pain caused by the pressure of the compressed vertebrae ^{8, 9}. Homoeopathic science is based on the principle of symptom similarity and individualization. Homoeopathic medicines help in preventing further progression of the disease pathology. The medicine is prescribed after detailed analysis and evaluation of the case. Previous studies have assessed homeopathic medicines' role in cervical spondylosis ¹⁰. The main aim in this case was to alleviate pain caused by the compressed vertebrae and avoid the disease from progressing further; thereby improving the patient's quality of life.

Case Presentation: A 58 years old menopausal female presented complaints of neck pain and tingling and numbness of the left hand for the past 1 month. Pain gradually increased in intensity over the last month when she did some heavy furniture shifting work. Pain was lightening-like and better by warmth and worse while sitting and in cold weather. She also complained of stiffness and numbness over the affected part. There was no history of trauma, fall or accident. No history of any other major illness noted. No history of any major surgeries in the past. Patient was thirsty and thermally chilly. There was no change in bowel or bladder habits of the patient. She was highly anxious. She was very fastidious in nature and constantly felt the need to be doing something. Local examination of the neck revealed no bony contours, deformities, and palpation showed no change in the temperature of the skin at the cervical region. There was severe pain present on extension of the neck. (Lhermitte’s sign positive) CNS examination did not show any change in power of both upper limbs. No muscle wasting or weakness over the affected upper limb. On examination, the patient's blood pressure was 130/80 mm of Hg and the pulse rate was 88 beats per minute. To confirm the diagnosis patient was advised to perform X-ray cervical spine (Antero-posterior and Lateral view). Fig. 1 shows the X-ray of the cervical spine (antero-posterior and lateral view) showing the presence of degenerative changes in the form of anterior & posterior osteophytes with slightly reduced intervertebral disc space at C5-C6, C6-C7 vertebrea, suggestive of changes of cervical spondylosis.

FIG. 1: X-RAY CERVICAL SPINE (AP AND LATERAL VIEW)

Analysis of Case: The totality of symptoms was formed after detailed case analysis and evaluation. Repertorization was done by using RADAR software. Fig. 2 shows the repertorization sheet along with the close-coming group of remedies. The final remedy was selected, which had the highest marks in the repertory sheet and covered all the patient's symptoms. Rhus toxicodendron 200 three times a day for 7 days was prescribed.

FIG. 2: REPERTORIZATION SHEET

Intervention: Medicine was given to patient on the basis of the presenting totality and given orally in the form of pills. Potency and repetition of dose was decided based on individualization. Medicine from the sealed bottle from the same batch and from a G. M. P (Good Manufacturing Practice) certified standard pharmacy was administered orally.

Follow-up:

RESULT AND DISCUSSION: 58 A old female patient who presented with neck pain and tingling numbness over their left hand witnessed relief after taking Rhus toxicodendron 200. After a detailed interview, a totality was formed, and repertorization was done. Close coming group of remedies was compared, and Rhus toxicodendron was selected based on the action of the medicine.

As cervical spondylosis is a degenerative disease and irreversible pathological changes take place at the level of the vertebrae, the strength of our medicines lies in their property to abort the further progression of the disease pathology & arrest the growth of osteophytes at the stage where they are identified. Patient was diagnosed with osteophytic changes at the C5-C6 and C6-C7 levels. There was no restriction of movements noted. Patient had been advised to use a soft cervical collar (medium size) for neck support to prevent the impact of any sudden movements & jerks on the cervical vertebrae. The patient had anxiety due to neck pain, so she was advised to practice pranayama daily. Case was assessed with the help of Copenhagen neck function disability test during the follow-up. The Copenhagen Neck Functional Disability Scale was used to assess the treatment outcome. It consists of 15 questions. These questions are individually answered by either ‘YES’, ‘OCCASIONALLY’ or ‘NO’. For questions 1-5, a ‘YES’ indicates a score of 0, ‘NO’ indicates a score of 2. For questions 6-15, a ‘NO’ indicates a score of 0 and ‘YES’ indicates a score of 2, the answer ‘OCCASIONALLY’ always receives a score of 1. Fig. 3 shows the Copenhagen neck function disability scale score, which was 9 before starting the treatment and after taking the medicine the score was 1 Fig. 4. This shows that the line of treatment which was followed was correct and the patient was feeling better with the prescribed medicine.

FIG. 3: (BEFORE TREATMENT)                       

FIG. 4: (AFTER TREATMENT)

Outcome was also assessed with the help of Modified Naranjo criteria as follows ¹¹:

TABLE 1: MODIFIED NARANJO CRITERIA ¹¹

CONCLUSION: Cervical spondylosis is a condition that hampers patients' overall quality of life due to pain and disability. The patient initially had severe neck pain that interfered with her capacity to perform daily activities and sleep disturbance at night. After taking the medicine, the patient could perform her day to day activities without difficulty, and her sleep improved. Homoeopathic medicines, when prescribed on the principles of individualization, help improve patients' overall well-being.

Though cervical spondylosis is a degenerative disease, our medicine i.e. Rhus toxicodendron was selected; as the main sphere of action is on the musculoskeletal system leading to rheumatic pain from straining of the affected part. Pain typically is aggravated by cold weather and ameliorated by warmth. The Copenhagen neck function disability score before and after treatment also differed. The case was also assessed as per the Modified Naranjo criteria ¹¹ Table 1 for Homoeopathy, and the total score was 9.

This suggests a causal relationship between the case and homoeopathic medicine prescribed. Thus, we can conclude that the homoeopathic medicine Rhus toxicodendron 200 and the use of a soft cervical collar for neck support and prananyama helped achieve results. Thus, we can conclude that, when the case presents to us at an early stage of cervical spondylosis our medicine; when selected on the basis of symptom similarity can help to abort the further progress of the disease pathology & prevent further complications.

Informed Consent: ‘Written Informed Consent’ was taken from the patient, and they agreed to undergo the treatment under the treating Homoeopathic doctor. Also, Consent was taken to publish pictures and data in journals.

ACKNOWLEDGEMENT: Authors would like to thank Hon’ble Chancellor of Dr. D.Y. Patil Vidyapeeth, Pune, Dr. P. D. Patil, for his constant support. The authors would like to thank the Hon’ble Trustee of Dr. D.Y. Patil Vidyapeeth, Dr. Smita Jadhav, for her constant source of inspiration. The authors would also like to thank the Vice Chancellor of Dr. D.Y. Patil Vidyapeeth, Pune, Prof. Dr. N. J. Pawar, for his constant support & guidance. The authors would also like to thank the Registrar of Dr. D. Y. Patil Vidyapeeth, Pune, and Dr. A. N. Suryakar Sir for all his administrative support and guidance. The authors would also like to thank the patient and his relatives for cooperating.

Financial support: Nil

CONFLICTS OF INTEREST: The authors declare no conflict of interest.

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    How to cite this article:

    Kulkarni RB, Aphale PS and Sharma DB: Homoeopathic management of an acute case of cervical spondylosis: a case report. Int J Pharm Sci & Res 2023; 14(12): 5701-15. doi: 10.13040/IJPSR.0975-8232.14(12).5701-15.

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