Effect of three-volt moxibustion with helium-neon laser irradiation on quality of care in patients with lumbar radiculopathy spondylosis

Abstract

BACKGROUND

Lumbar radiculopathy spondylosis is a relatively common orthopedic disease with a high incidence rate. It most commonly occurs in the lumbar 4-5 and lumbar 5-sacral 1 vertebrae, which account for approximately 95% of cases. It mostly occurs in people aged 30-50 years old and greatly affects their quality of life.

AIM

To determine the effect of triple-voltage acupuncture combined with helium-neon laser irradiation on the quality of care and improvement of symptoms in patients with lumbar radiculopathy spondylolisthesis.

METHODS

In this study, we selected 120 patients with lumbar radiculopathy spondylosis who were treated at our hospital between June 2019 to June 2020. The patients were divided into control and observation groups according to the random number table method, with 60 patients in each group. Patients in the observation group were treated with three-volt moxibustion combined with helium-neon laser irradiation, and those in the control group were treated with lumbar traction. After 1 month of treatment, the lumbar pain scores, lumbar spine motor functions, clinical treatment effects, and nursing satisfaction of the two groups were compared.

RESULTS

The results showed that acupuncture combined with laser irradiation significantly improved the patients' clinical symptoms, i.e., reduced their low back pain, significantly lower numerical rating scale pain scores in the observation group than in the control group, and better lumbar spine motility than in the control group, compared to lumbar traction. In addition, they were cared for. The treatment effectiveness rate of the observation group was 95.5%, which was significantly higher than that of the control group (81.67%). Satisfaction with care was higher than 90 points in both groups, but the difference was not statistically significant.

CONCLUSION

Our study provides a clinical rationale for the future treatment of patients with lumbar spine disease. However, further extensive research is needed for validation.

Key Words: Moxibustion; Laser irradiation; Clinical rationale; Lumbar spine; Three-volt moxibustion

Core tip: This study investigated the effects of three-volt moxibustion combined with helium-neon laser irradiation on the quality of care and symptom improvement in patients with lumbar radiculopathy-type cervical spondylosis. The results showed that this therapy can effectively improve the quality of care and significantly relieve patients' symptoms, providing a new effective means for the treatment of cervical spondylosis.

INTRODUCTION

Lumbar radiculopathy spondylosis is a prevalent spinal disorder that significantly affects patients' quality of life and their physical and mental well-being[1]. The primary symptoms of this condition include lower back pain and sciatica, which, in extreme cases, can lead to restrictions in patient activity[2]. Although the exact prevalence of lumbar radiculopathy spondylosis is unknown, it is often associated with conditions such as herniated lumbar discs, lumbar spinal stenosis, and sciatica[3]. This disease also has a profound impact on the patients' quality of life and physical and mental health. Currently, a range of treatment methods is available for lumbar radiculopathy spondylosis, including medication, physiotherapy, traction, and acupuncture. However, these conventional treatments may not be effective for some patients, necessitating the exploration of new treatment options to improve overall treatment outcomes[3].

In recent years, three-volt moxibustion (TCM) and helium-neon laser irradiation have received increasing attention from the medical community as traditional Chinese medicine and physiotherapy methods[4]. TCM can relieve pain and improve symptoms by stimulating acupuncture points and adjusting the flow of qi and blood[5]. Helium-neon laser irradiation, with its anti-inflammatory, analgesic, and tissue repair-promoting effects, has been widely used to treat various pain and inflammatory diseases[6]. The combined application of these two methods allows for fully utilizing their respective therapeutic advantages, and further improving the therapeutic effects in nerve root-type lumbar spondylosis. However, there is a lack of clinical applications using these two combined approaches in patients with lumbar radiculopathy spondylosis at this stage of research. Several studies have shown that Chinese medicine has achieved remarkable results in the treatment of lumbar radiculopathy spondylosis[7]. TCM care methods such as acupuncture, tuina, Chinese herbs, and rehabilitation training can effectively relieve pain, improve cervical spine mobility, and enhance quality of life. For example, a randomized controlled trial showed that acupuncture can effectively relieve pain and numbness in patients with lumbar radiculopathy spondylosis and is more effective than conventional drug treatment[8].

This study aimed to investigate the effects of TCM combined with helium-neon laser irradiation on the quality of care and symptom improvement in patients with lumbar radiculopathy and spondylosis. In this randomized controlled study, we analyzed and compared the effects of three-voxel moxibustion combined with helium-neon laser irradiation in the treatment of lumbar radiculopathy spondylolisthesis and its effect on patients' quality of life. The results of this study will provide clinicians with new therapeutic options that will help improve the therapeutic effects and quality of life of patients with lumbar radiculopathy and spondylosis.

MATERIALS AND METHODS

Research participants

In this study, we enrolled 120 patients with lumbar radiculopathy spondylosis who received treatment at our hospital between June 2019 and June 2020. The patients were divided into control and experimental groups according to the random number table method, with 60 patients in each group. The study subjects had lumbar radiculopathy spondylosis, and the inclusion criteria for the study subjects were as follows: (1) Presence of symptoms such as low back pain and lower limb numbness; (2) Herniated lumbar intervertebral discs, degeneration of the intervertebral joints, and other factors leading to nerve root compression; and (3) The patient was conscious and could answer the medical staff's questions independently. The exclusion criteria were as follows: (1) Non-nerve root lumbar spondylosis, such as spinal cord lumbar spondylosis; (2) Severe lumbar spine lesions that cannot be treated with lumbar traction or other treatments; and (3) Combination of other diseases such as stroke and diabetes. The diagnostic criteria for lumbar radiculopathy spondylosis are as follows: (1) Lumbar pain and leg pain radiating along the distribution area of the nerve root aggravated by increasing abdominal pressure; (2) Leg numbness and weakness; (3) Sensory disturbances (widespread or limited), a positive straight leg raising test, limited forward flexion and backward extension, lumbar pain due to lumbar scoliosis, paraspinal tenderness, decreased muscle strength, and decreased or absent Achilles tendon reflexes; and (4) Imaging as a diagnostic tool for lumbar nerve root cervical spondylosis. Magnetic resonance imaging (MRI) can be regarded as the most suitable noninvasive means of examination for lumbar disc herniation at this stage, with a positive rate higher than that of computed tomography. MRI can accurately show spinal cord and nerve root compression and edema or degeneration, and has a good display of spatial microstructure.

In the control group, there were 32 males and 28 females, aged 45-70 years (mean 58.3 ± 6.7 years old), and in the observation group, there were 34 males and 26 females, aged 44-72 years (mean 59.1 ± 7.3 years old). There were no statistically significant differences between the two groups in terms of sex, age, or illness (P > 0.05) (Table 1).

Table 1 Basic information about the study population.

		Control	Observation	t/χ2	P value
Gender	Male	32	34	1.53	0.097
	Female	28	26
Aged		58.3 ± 6.7	59.1 ± 7.3	1.64	0.061
Duration of illness (month)		6.5 ± 3.3	7.0 ± 2.5	1.21	0.075
Take care of oneself	Yes	49	47	1.79	0.057
	No	11	13	-	-

Research design

This was a randomized controlled study in which 120 subjects were equally divided into an observation group and a control group. The observation group were treated with TCM combined with a helium-neon laser irradiation care mode, whereas the control group were treated with lumbar traction care.

Observation group nursing mode: TCM combined with helium-neon laser irradiation The TCM position tonifies Yang and drives away cold and overall regulation. One Qihuang moxibustion point was placed on the Da vertebrae, life gate, kidney Yu, Changqiang, danzhong, Guanyuan, foot Sanli, Sanyinjiao, Yongquan for 25 min once a day for 20 d. An interval of 3-5 d was established before performing another course of treatment. A JH30C laser therapeutic instrument was used with a wavelength of 632.8 mm, output power of 40mV, and spot diameter of 2 cm for the irradiation of pressure pain points. In addition, the end of the He-Ne laser fiber was close to the patients’ Huanjiao, Lumbar Yangguan, Kidney Yu, Vital Gate, Huizhong, Chengshan, and the key points for acupoint irradiation, and each acupoint was irradiated for 5 min once a day for 20 d. Another course of treatment was administered every to 3-5 d.

Control group: Lumbar traction nursing mode. Lumbar traction is commonly non-surgical treatment used to treat patients with lumbar disc herniation as a form of rehabilitation treatment, as well as lumbar spinal stenosis. This finding is of great significance for the care of patients with lumbar traction. This study focuses on patient care using traction beds. In patients undergoing lumbar traction, are usually placed in the supine or prone position, with the upper half of the body for the corresponding fixed, fixed in the lower limbs of the affected limbs to perform the corresponding skin traction, such as the application of a skin traction fixed band, fixed in the fixed band at the end of the fixed band, that is, the corner of the bed position, placed in the corresponding weight.

Measure indicators

Assessment of the level of lower back pain: This study focused on the assessment of low back pain in patients using the numerical rating scale (NRS), a commonly used pain rating scale that uses numbers from to 0-10 to represent different levels of pain, with 0 indicating no pain and 10 indicating the most severe pain. Patients can choose an appropriate number to represent their level of pain.

Functional assessment of lumbar movement: The assessment of lumbar range of motion mainly refers to the range of motion of the lumbar region when performing movements such as forward flexion, backward extension, lateral bending, and rotation. In this study, lumbar spine function was mainly assessed using the Japanese Orthopedic Association scores (JOA) scoring standard[9]. The highest JOA score was 29, and the lowest was 0. A higher score indicated a better functional status of the lumbar spine, and a lower score indicated more obvious dysfunction. The JOA is divided into 4 grades, with 25-29 as excellent, 16-24 as good, 10-15 as moderate; and < 10 as poor.

Clinical improvement in the patients: In a comparison of treatment efficiency between the two groups, based on the disappearance of pain and recovery of motor function. Cases wherein pain completely disappeared, motor function completely recovered as significantly effective, pain basically disappeared, or motor function basically recovered was considered “effective". Whereas, cases where pain had not disappeared or was aggravated, motor function had not been restored, or motor limitation was aggravated were considered “ineffective". The total effective rate of the treatment = (significantly effective + effective)/total number of cases × 100%.

Satisfaction with care: In this study, nursing care satisfaction was formulated based on the content of daily nursing care for lumbar diseases, and each question was rated using a 5-level scale, such as "very satisfied", "satisfied", "average", "dissatisfied", and "very dissatisfied", with a total of 20 questions and a total score of 100, with the higher score representing a higher satisfaction of the patients and their families with the nursing care model.

Statistical analysis

A database was set up, and the data were entered using Epidata after double-checking. SPSS software (version 26.0) was used to analyze the data. Count data were analyzed using the χ² test. Measurement data were expressed as mean ± SD. The two groups before and after the intervention were compared using repeated-measures ANOVA, the two groups were compared using the two independent samples t-test, and the two groups within the groups were compared using the least significant difference procedure. Statistical significance was set at P < 0.05.

RESULTS

Differences in patients' low back pain scores before and after treatment

Comparing and analyzing the pain levels of the two groups of patients before and after treatment, the results showed that after clinical treatment and care, the NRS pain scores of the patients in the observation and control groups decreased, and there was a significant difference in the pain scores between the observation and control groups (Table 2).

Table 2 Differences in low back pain scores before and after patient treatment.

	NRS		H/t	P value
	Before	After
Observation group	7.83 ± 0.55	1.74 ± 0.48a	19.891	0
Control group	7.65 ± 0.44	3.14 ± 0.52a	14.214	0
H/t	-0.134	3.066	-	-
P value	0.893	0.002	-	-

^aP < 0.05.

H: Kruskal-Wallis H test; NRS: Numerical rating scale.

Assessment of lumbar spine motor function before and after patient treatment

Comparing and analyzing the lumbar spine motor function of the two groups of patients before and after treatment, the results showed that after clinical treatment and care, the lumbar spine function of the patients in the observation and control groups improved, and there was a significant difference in the lumbar spine motor ability between the observation and control groups (Table 3).

Table 3 Differences in low back Japanese Orthopedic Association scores before and after patient treatment.

	Japanese Orthopedic Association scores		H/t	P value
	Before	After
Observation group	6.73 ± 0.63	18.26 ± 0.61a	12.768	0
Control group	5.94 ± 0.23	14.23 ± 0.42a	11.356	0
H/t	0.789	7.875	-	-
P value	453	0	-	-

^aP < 0.05.

H: Kruskal-Wallis H test.

Comparison of clinical outcomes after treatment between the two groups of patients

The clinical treatment efficiency of the two groups was analyzed and compared, and it was found that the clinical treatment efficiency of the observation group was 95.5% and that of the control group was 81.67%, with a significant difference between the two groups (P < 0.05) (Table 4).

Table 4 Comparative analysis of the clinical outcomes of the two groups of patients, n (%).

Group	n	Significantly effective	Effective	Ineffective	Effective rate
Control group)	60	32 (53.3)	25 (41.67)	3 (0.05)	57 (95.5)
Observation group	60	23 (38.33)	26 (43.33)	11 (18.33)	49 (81.67)
χ2 value	-	-	-	-	45.759
P value	-	-	-	-	0.000

Patient care satisfaction scores in both groups

The satisfaction scores of the two groups of patients for the nursing care model were collected, and the results showed that the nursing care satisfaction scores of the two groups were above 90, and there was no significant difference between the scores. Therefore, it was concluded that the nursing care model of three-voxel moxibustion combined with helium-neon laser irradiation was better accepted by patients with lumbar radiculopathy spondylolisthesis (Table 5).

Table 5 Satisfaction scores in two groups.

Group	Satisfaction scores
Observation	93.20 ± 3.5
Control	91.90 ± 2.5
t	4.421
P value	0.061

DISCUSSION

This study to explore the TCM combination of helium neon laser irradiation of nerve root lumbar disease nursing quality and the impact of the improvement of clinical symptoms, using randomized controlled study analysis, the results showed that compared to waist traction nursing, acupuncture combined laser irradiation significantly improved the clinical symptoms of patients. Moreover, they also received satisfactory care. The treatment effectiveness rate in the observation group was 95.5%, which was significantly higher than that in the control group (81.67%). Patient satisfaction with nursing in both groups was higher than 90 points; however, the difference was not statistically significant.

Pain is a common symptom of a wide range of diseases and conditions, and has a significant impact on the quality of life and health of patients. Therefore, selecting effective treatments to relieve pain is necessary[10]. The results of this study showed that acupuncture and laser irradiation were effective in relieving pain and were superior to lumbar traction. Acupuncture and laser irradiation may relieve pain by regulating the circulation of qi and blood in the body[11,12], unblocking the meridians, and promoting inflammation. In addition, acupuncture and laser irradiation have the advantages of ease of operation, safety, reliability, and few adverse effects. In a previous study of patients with low back pain, acupuncture was found to be effective in reducing musculoskeletal pain and improving patients' quality of life. In the present study, laser irradiation may have significantly enhanced the effects of acupuncture, and the combination of acupuncture and laser irradiation was more effective in clinically improving lumbar radiculopathy spondylolisthesis than lumbar traction therapy.

In addition to the effective improvement of pain, in this study it was also found that the observation group showed significant results in improving the lumbar spine function of the patients[13]. Compared to the control group, the observation group showed significantly improved JOA scores within the same treatment period. Previous studies have shown that acupuncture improves lumbar spine function, and laser irradiation has been widely used to treat muscle and joint injuries. For example, Boyraz et al[14] applied laser acupuncture to treat patients with osteoarthritis; the results showed that this treatment method significantly reduced the patients' pain scores, and its therapeutic effect achieved significant results after 2 wk of treatment. Based on previous studies, it is believed that three-volt acupuncture combined with helium-neon laser irradiation has fewer side effects and a shorter onset of action in the clinical treatment of radiculopathy.

Our study is the first to use a combination of triple-voltage acupuncture and helium-neon laser irradiation for the treatment of radiculopathy and to achieve better clinical results. Our study has the following limitations. First, our study used a randomized controlled study, but due to the strict selection criteria for the study population, we were unable to include a large sample of cases, thus leading to impoverishment of the robustness of the results of our study; we need to further include more study subjects in the future to carry out the study. The second limitation is that the laser irradiation method we used was helium-neon laser irradiation, ignoring the effectiveness of other laser irradiation methods; therefore, future comparisons with other laser irradiation treatments are needed to obtain the best therapeutic effect on patients.

CONCLUSION

Lumbar radiculopathy spondylosis can significantly reduce the quality of life of patients and has a significant impact on their lives and work. In this study, through the use of TCM combined with helium-neon laser irradiation, the pain scores of the patients and function of their lumbar vertebrae improved significantly after treatment, and the study found that the patients' clinical therapeutic efficacy and satisfaction with the nursing care were higher after receiving the treatment. Our study provides a clinical rationale for the future treatment of patients with lumbar spine disease. However, further extensive research is needed for validation.