Nghiên cứu tác dụng điều trị thoát vị đĩa đệm cột sống cổ của phương pháp kéo giãn bằng nẹp không khí kết hợp phác đồ điều trị bảo tồn tt tiếng anh

BACKGROUND
Spinal disc herniation is a fairly common disease, with the
most prevalent type is cervical disc herniation, especially in people
over 50 years of age.
This condition usually manifests itself in the form of neck
pain, neck-shoulder pain, neck-shoulder-arm pain, neck-shoulderhand pain, hypoesthesia or paraesthesia, limbs weakness or paralysis,
dizziness,nausea and vomiting,... resulting in the reduction ofwork
capacity and quality of life and affecting the patients’ activities of
daily living.
The treatment of cervical disc herniation is aimed at restoring
neurological functions, reducing pain and improving the patients’
quality of life. There have been many effective methods such as
physiotherapy, cervical traction, analgesics, anti-inflammatory drugs,
muscle relaxants, cervical nerve root blockade procedure or
discectomy,... however, most patients respond well to conservative
treatment.
Cervical traction is an effective conservative treatment due to
its effects on the pathogenetic mechanisms of cervical disc
herniation. The disadvantage of cervical tractiondevices such as
braces or beds is that treatment can only be performed in certain
facilities equipped with those equipment and patients must rest
completely during the traction process and wear a traction collar after
the process. To overcome this drawback, the inflatable cervical
traction device has been put into use and initially proven to have
many advantages due to its flexibility, lightness, simplicity and
convenience. The device can also be used at home but still ensure its
therapeutic effects.
However, as these issues have not been systematically
investigated, we conducted this research to:
1. Review the clinical features, results of magnetic
resonance

imaging
(MRI)
technique
and
several
neurotransmission indicators in patients with cervical disc
herniation.


2. Assess the treatment of cervical disc herniation by
inflatable cervical traction collar in combination with conservative
treatment regimen in the patient group.
2. Rationale
Cervical disc herniation is a spondylosis and herniated disc
disease. On the basis of spondylosis, it forms osteophytes stimulating
and compressing the nerve roots or narrowing the spinal diameter and
causing different degrees of cervical cord compression. If it is left
untreated, it often results in the reduction of work capacity and
quality of life and affecting the patients’ activities of daily living.
Although there have been many clinical, diagnostic and therapeutic
studies within Vietnamand around the world, more research needs to
be done to improve theeffective treatmentof this disease. Therefore, a
systematic evaluation of the outcomes of inflatable cervical traction
collar in combination with conservative treatment regimenfor
cervical disc herniationin Vietnam is necessary as this is a simple yet
effective treatment method for this common disease.
3. Significance of the thesis
The thesis provided information on the experience and
effects of traction methods using inflatable traction device in the
conservative treatment of cervical disc herniation in Vietnam. 2

weeks after the treatment: 90.74% of patients in the treatment group
experienced improvement of symptoms, 55.56% higher than the
control group (p <0.001). 6 months after the treatment: 100% of the
patients in the treatment group experienced improvement of
symptoms, with up to 87% of which had very good improvements.
During the treatment of cervical disc herniation using inflatable
cervical traction collar in combination with conservative treatment
regimen, we did not encounter any accidents or complications.

4. Structure of the thesis:
The thesis consists of 132 pages including: 2 pagesof
background, 34 pages of literature review, 23 pages ofresearch
objects and methods, 39 pages of results, 30 pages of discussion, 3
pages of conclusion and 1 page of recommendation.


The thesis has 42 tables, 11 charts, 164 references including 14
and 150 documents written in Vietnamese and English language,
respectively.
CHAPTER 1
LITERATURE REVIEW
1.1. Anatomy profile, cervical spine function
1.2. Pathogenesis and aetiology of cervical disc herniation
1.2.1. Pathogenesis
Disc herniation is a consequence of the spondylosis process
that begins in the nucleus pulposus, followed by the annulus fibrosus
of the intervertebral disc and usually takes place after major traumas
or minor injuries. The process of spondylosis progresses with age and
often develops in differentparts of the spine.
1.2.2. Aetiology

There have been many studies investigating the causes and
mechanism of cervical disc herniation. Most authors emphasized two
mechanisms of cervical spondylosis and trauma, of which
spondylosis played a major role. Currently, the studies of
pathogenesis and aetiologyare still continuingly being conducted.
1.3. Classifications of cervical disc herniation
1.4. Clinical symptoms
Cervical disc herniation has a very diverse clinical landscape
that varies depending on the location, type, severity and stage of the
disease. The common clinical syndromes are: simple nerve root
compression syndrome, simplecervicalcord compression syndrome,
nerve root and cervical cord compression syndrome, dysautonomia.
The majority of studies only described the first three syndromes.
However, there are still some papers mentioning all four of these
syndromes.
1.5. Sub-clinical symptoms
Subclinical diagnostic methods include: routine X-ray,
computer tomography (CT), MRI, electromyography, and nerve
conduction studies.
1.5.1. Routine X-ray of cervical spine
1.5.2. CT
1.5.3. MRI
1.5.3.1. Images of herniated disc on MRI films


On MRI films, the herniated discscoincide with the discs
protruding from the posterior longitudinal ligament and donot absorb
MRI contrast agent.
+ The sagittal plane helps assess the entire cervical spine,
including the positions and number of herniated discs.

+ The axial plane shows the types of central, paracentral and
subarticular herniation. A combination of both sagittal and axial plane
can assess the extent of a herniated compression on the spinal cord
and nerve root, causing compression of the cerebrospinal fluid and
bone marrow edema at the same level.
1.5.3.2. Classifications of cervical disc herniation based on
MRI films
MSU classification
The MSU classification was based on both the size and
position of herniation displayed on the MRI film, in relation to the
appropriate clinical symptoms to make surgical decision.
“The degree of nerve compression” by Nguyen Van
Chuong
In 2015, the author Nguyen Van Chuong proposed
using“The degree of nerve compression” displayed on the MRI
film to evaluate the degree of compression caused by herniated disc,
ensure the risk of cervical cord and nerve root compression to be
similar with each other. “The degree of nerve compression” can be
applied to diagnose and monitor the clinical treatment outcomes of
disc herniation and should be investigated more for further
improvement.
1.5.4. Electromyography
1.5.5. Nerve conduction studies
Nerve conduction
studies
in
combination with
electromyography facilitate the diagnosis of neurological distribution
loss. Nerve conduction studies include the measurement of distal
latency (motor and sensory), nerve conduction velocity (NCV)

including motor conduction velocity (MCV), sensory conduction
velocity (SCV) and F-wave latency (motor). It can only be measured
on a certaintypes of nerves such as the median, ulnar and radial nerve
for the upper limb, posterior tibial, sural/saphenous and superficial
fibularor deep fibularnerve for the lower limb.


1.6. Treatment
Current treatment methods for cervical disc herniation include
conservative treatment, surgical treatment and other interventions.
1.6.1. Conservative treatment
1.6.1.1. Indications for conservative treatment
1.6.1.2. Conservative treatment methods
- Fixed cervical spine
- Medication
- Cervical spine traction
Cervical spine traction is a classic yet modern treatment method
The effects of cervical spine traction are:
+ reduction of the intradiscal pressure
+ adjustment of the protrusion of the vertebrae and spine
+ reduction of the nerve root compression
+ passive muscle relaxation.
Clinically speaking, spinal traction brings about positive
results: reduction of spinal pain syndrome, nerve root compression
syndrome, scoliosis, muscle spasticity and increase of spinal mobility
and flexibility.
There are many spinal traction methods such as continuous
traction, body weight traction, counterweight traction, underwater
traction, traction with impulses,... with many different traction
devices. Each type of device has its own advantages and

disadvantages. One of which is the inflatable traction device, which
has been put into use and initially proven to have many advantages
due to its flexibility, lightness, simplicity and convenience but still
remains its therapeutic effects. The device Disk Dr CS-300 from
Changeui Medical brand (Korea) was made with the improvement in


traction power as well as comfort for users during the treatment
process.
- Physiotherapy
- Massage
According to some studies, message has proven to be
effective if done correctly.
1.6.2. Minimally invasive interventions
1.6.2.1. Percutaneous laser disc decompression
1.6.2.2. Chemonucleolysis
1.6.2.3. Radiofrequency disc decompression
1.6.2.4. Percutaneous laparoscopic discectomy
1.6.3. Surgical treatment
CHAPTER 2
RESEARCH SUBJECTS AND METHODS
2.1. Research subjects
Including 99 patients having cervical disc herniation confirmed
by clinical diagnosis and CT scan. All of these patients were treated at
the Neurology Department – Military Medical Hospital 103 and the
Neurology Department - Military Medical Hospital 354 - General
Logistics Department from December 2012 to December 2015.
2.1.1. Inclusion criteria
- Clinical
+ Had cervical spine syndrome

+ Had at least one of the following syndromes:
* Cervical nerve root compression syndrome.
* Cervical cord compression.
* Dysautonomia and Vertebrobasilar insufficiency syndrome.
- Sub-clinical
+ Cervical disc herniation on CT film.
+ Clinical symptoms and syndromes consistent with the
location of herniation on MRI film
2.1.2. Exclusion criteria
- Cervical disc herniationwith fragments,osteophytes and
overgrowth of zygapophyseal joint
- Cervical disc herniationaccompanied by other neurological
and internal medical diseases: polyneuropathy, amyotrophic lateral
sclerosis, myeloma, myelitis, spinal cord injury, coagulopathy, liver


failure, kidney failure, tuberculosis, fever, intervertebral disc necrosis
due to tuberculosis, spinal cancer, diabetes, alcoholism, peripheral
neuropathy.
- Patients underwent spinal surgery due to disc herniation and
trauma.
- Patients under 18 and over 70 years of age.
- Patients did not consent to the study.
* Patients were randomised into two groups:
- Treatment group (54 patients):treated with inflatable
cervical traction device in combination with conservative treatment
regimen.
- Control group (45 patients): patients treated with
conservative treatment regimen only without inflatable cervical
traction device.

2.2. Methods
2.2.1. Study design
A prospective, cross-sectional study with comparative control.
2.2.2. Sample size
Sampling method: convenient sampling for both groups.
2.2.3. Research facilities
- Philips MRI scanner ACHIEVA 1.5 Tesla at the Diagnostic
Imaging Department, Military Medical Hospital 103.
- NIHON-KONDEN (Japan) neurotransmitter at the Neurology
Department – Military Medical Hospital 103.
- Cervical traction brace Disk Dr CS-300 fromChangeui Medical
brand (Korea).
2.2.4. Research procedure
2.2.4.1. Develop research outline and data collection form (Appendix)
2.2.4.2. Clinical examination
2.2.4.3. MRI scan for cervical spine
- MRI scan for cervical spine was carried out at the
Diagnostic Imaging Department, Military Medical Hospital 103, at
two times (before the treatment and 2 weeks after the treatment).
Particularly, for the treatment group, MRI scan was additionally
performed 6 months after the treatment
2.2.4.5. Electromyography


The NIHON-KONDEN (Japan) device NEUROPACK was
used.It is positioned in a standard room (average temperature of 24260C) at the Neurology Department – Military Medical Hospital 103.
Table 2.1. Normal values of motor nerve conduction
Measurements
Median nerve Ulnar nerve
distal motor latency (DML)* (ms)

4,2
3,5
Amplitude (mV)
> 4,0
> 6,0
motor conduction velocity (MCV) (m/s)
59,3 ± 7,0
58,9 ± 4,4
F-Latency** (ms)
26,6 ± 4,4
27,6 ± 4,4
*: DML - distal motor latency.
**: F-wave latency, average of the F-wave sequence obtained from
16 electrical stimulation.
Table 2.2. Normal values of sensory nerve conduction
Measurements
Median nerve Ulnar nerve
distal sensory latency (DSL) (ms)
3.5
3.1
SNAP Amplitude (µV)
>20.0
> 17.0
sensory conduction velocity (SCV)m/s
67,7 ± 8,8
64,8 ± 7,6
2.2.4.6. Conservative treatment regimen
The patients were treated according to a unified protocol at
the Neurology Department at Military Medical Hospital 103.
2.2.4.7. Inflatable traction brace Disk Dr CS-300

The spinal traction brace Disk Dr CS-300 fromChangeui
Medicalbrand (Korea) can be used at home. The traction power is
approximately 30 pounds, internal pressure is0,4kg/cm 2. The brace
should be used 3 times per day (in the morning, noon and evening),
30 minutes each time, for 6 months.
2.2.5. Indicators
Clinical indicators, MRIscan and Electromyography were
carried out before and 2 weeks after the treatment in both groups; the
examination was performed 6 months after the treatment with the
patients in treatment group.
2.3. Data analysis
Using SPSS software version 20.0.
2.4. Ethics
- Ethics were ensured in this study.


PART 3
RESULTS
3.2. Clinical results in the study subjects.
Table 3.5. Clinical syndrome before treatment
Group
Treatment
Control
Total
group (n=54) group (n=45)
(n=99)
Syndrome
n
%
n

%
n
%
Cervical spine syndrome
54
100
44
97.78
98
98.99
Nerve root compression
43
79.63
34
75.56
77
77.78
syndrome
Cervical cord
4
7.41
6
13.33
10
10.10
compression syndrome
Nerve root and cervical
cord compression
7
12.96

5
11.11
12
12.12
syndrome
Dysautonomia
15
27.78
11
24.44
26
26.26
Table 3.6. Cervical spine syndrome before treatment
Group
Treatment
Control group
Total
group (n=54)
(n=45)
(n=99)
Syndrome
n
%
n
%
n
%
Pain and spasticity of
54
100

44
97.78
98
98.99
cervical spine
Limited mobility of cervical
54
100
44
97.78
98
98.99
spine
Pain in cervical spine
54
100
44
97.78
98
98.99
Table 3.7. Nerve root compression syndrome before treatment
Group
Treatment
Control group
Total
group (n=54)
(n=45)
(n=99)
Symptoms
n

%
n
%
n
%
Nerve root paraesthesia
41
75.93
34
75.56
75 75.76
Increased
pain
when
3
5.56
0
0
3
3.03
coughing or sneezing
Decreased pain during spinal
43
79.63
34
75.56
77 77.78
traction
Upper limb numbness
43

79.63
33
73.33
77 77.78
Spurling’s sign
29
53.70
28
62.22
57 57.58

p

0.46
0.63
0.51
0.78
0.71
p

0.46
0.46
0.46
p

0.97
0.25
0.63
0.46
0.39

Doorbell sign
2
3.70
2
4.44
4
4.04
Cervical nerve root motor
14
25.93
5
11.1
19 19.19
disorder
Cervical nerve root sensory
26
48.15
23
51.11
49 49.49
disorder
Upper limb amyotrophy
4
7.41
3
6.67
7
7.07

Table 3.8. Cervical cord compression syndrome before treatment
Treatment
Control
Total
Group
group (n=54) group (n=45)
(n=99)
Symptoms
n
%
n
%
n
%
Quadriplegia type "TW"
3
5.56
6
13.33
9
9.09
Brown- Séquard symptom
1
1.85
0
0
1
1.01
Increased tendon reflex of
4

7.41
6
13.33
10
10.10
limbs
Babinski reflex
4
7.41
5
11.11
9
9.09
Hoffmann’s sign
4
7.41
5
11.11
9
9.09
Functional Hoffman’s sign
3
5.56
5
11.11
8
8.08
Hypoesthesia below damaged
4
7.41

5
11.11
9
9.09
level
Sphincter disorders type “TW”
2
3.70
1
2.22
3
3.03
Table 3.9. Dysautonomia and Vertebrobasilar insufficiency syndrome
before treatment
Treatment
Control group
Total
Group
group (n=54)
(n=45)
(n=99)
Symptoms
n
%
n
%
n
%
Occipital headache
17

31.48
13
8.89
30
30.30
Systemic vertigo
1
1.85
1
2.22
2
2.02
Unsystemic vertigo
13
24.07
10
22.22
23
23.23
Dizziness when changing
14
25.93
13
28.89
27
27.27
positions
Tinnitus
0
0

2
4.44
2
2.02
Table 3.10. Visual analogue scale before treatment
Group
Treatment group
Control
Total
(n=54)
group (n=45)
(n=99)
Visual analogue scale
n
%
n
%
n
%
Mild pain (VAS=1-2)

0

0

0

0

0

0

1.0
0.06
0.77
1.0
p
0.29
1.0
0.51
0.73
0.73
0.46
0.73
1.0

p
0.78
1.0
0.83
0.82
0.2
p

0.05


Moderate pain (VAS=35)
Severe pain (VAS=6-8)

14

25.93

39

72.22

Excruciating pain
(VAS=9-10)
Total

1

1.85

54

100

Average

2
2
2
3
0

48.89

36

36.36

51.11

62

62.63

0

1

1.01

99

100

4
100
5
5.73 ± 1.48

6.30 ± 1.50

6.04 ± 1.51

Table 3.11.Muscle strength scorebefore treatment
Group
Treatment group
Control
Total
(n=54)
group (n=45)
(n=99)
Muscle strength
n
%
n
%
n
%
score
5 points
35
64.81
31
68.89
66
66.67
4 points

12

22.22

10

22.22

22

22.22

3 points

7

12.96

4

8.89

11

11.11

2 points

0

0

0

0

0

0

1 points

0

0

0

0

0

0

54

100

45

100

99

100

Total
Average

4.50 ± 0.77

4.60 ± 0.65

4.55 ± 0.72

0.07
p

0.8

0.5

Table 3.12. Neck disability index (NDI) before treatment
Comparative
Treatment
Control
Total
p
criteria
group (n=54)
group
(n=99)
(n=45)
 ± SD
28.19 ± 6.04

25.84 ± 5.65 27.12 ± 5.95
0.0
Minimum
17
16
16
5
Maximum
46
41
46
3.3. Sub-clinical results
3.3.1. Nerve conduction study results
Table 3.13. Motor conduction velocity before treatment
Comparative criteria
Treatment
Control group
Total(n=99)
p
group (n=54)
(n=45)
( ± SD)


Motor
conduction
velocity of
median
nerve –
Right arm

Motor
conduction
velocity of
ulnar
nerve –
Right arm
Motor
conduction
velocity of
median
nerve –
Left arm
Motor
conduction
velocity of
ulnar
nerve –
Left arm

DML (ms)
MAw (mV)
MAe (mV)
MCV (m/s)

(± SD)
3.78 ± 0.73
7.6 ± 4.71
6.69 ± 3.92
55.84 ± 4.68

( ± SD)
3.6 ± 0.54
8.7 ± 5.25
7.68 ± 4.99
56.09 ± 4.01

3.69 ± 0.66
8.1 ± 4.97
7.14 ± 4.44
55.95 ± 4.37

0.18
0.27
0.27
0.78

DML (ms)
MAw (mV)
MAe (mV)
MCV (m/s)

2.77 ± 0.77
4.55 ± 2.78
4.05 ± 2.65
57.76 ± 6.18

2.57 ± 0.54
5.29 ± 3.58
4.5 ± 3.3
57.77 ± 5.17

2.68 ± 0.68
4.88 ± 3.17
4.26 ± 2.96
57.76 ± 5.72

0.16
0.25
0.46
1.0

DML (ms)
MAw (mV)
MAe (mV)
MCV (m/s)

3.73 ± 1.03
6.94 ± 4.56
6.15 ± 4.13
57.26 ± 6.96

3.52 ± 0.47
8.34 ± 6.07
7.17 ± 5.46
57.06 ± 4.13

3.63 ± 0.83
7.58 ± 5.32
6.61 ± 4.78
57.17 ± 5.82

0.21
0.19
0.29
0.87

DML (ms)
MAw (mV)
MAe (mV)
MCV (m/s)

2.88 ± 1.29
4.18 ± 2.32
3.61 ± 1.89
58.78 ± 5.57

2.67 ± 0.79
5.19 ± 3.03
4.33 ± 2.64
57.8 ± 4.56

2.79 ± 1.09
4.64 ± 2.7
3.94 ± 2.28
58.33 ± 5.13

0.35
0.06
0.12
0.35

Table 3.14. Sensory conduction velocitybefore treatment
Treatment
Control group
Total (n=99)
group (n=54)
(n=45)
Comparative criteria
( ± SD)
(± SD)
( ± SD)
Sensory
DSL (ms)
2.79 ± 0.33
2.73 ± 0.27
2.77 ± 0.3
conduction
SA (μV)
17.28 ± 9.5
17.19 ± 10.73 17.24 ± 10.03
velocity of
SCV(m/s)
48.41 ± 6.41
50.35 ± 6.32
49.25 ± 6.40
median nerve
– Right arm
Sensory
DSL (ms)
2.3 ± 0.24

2.24 ± 0.25
2.27 ± 0.25
conduction
SA (μV)
14.15 ± 9.31
14.96 ± 9.46
14.52 ± 9.34
velocity of
SCV(m/s)
51.02 ± 4.71
51.12 ± 5.87
51.06 ± 5.24

p
0.3
0.97
0.16
0.2
0.67
0.93


ulnar nerve –
Right arm
Sensory
conduction
velocity of
median nerve
– Left arm
Sensory

conduction
velocity of
ulnar nerve –
Left arm

DSL (ms)
SA (μV)
SCV(m/s)

2.77 ± 0.35
21.64 ± 12.28
48.91 ± 6.24

2.69 ± 0.33
18.99 ± 11.13
50.24 ± 6.15

2.73 ± 0.34
20.44 ± 11.79
49.51 ± 6.20

0.24
0.27
0.29

DSL (ms)
SA (μV)

2.23 ± 0.24
17.64 ± 10.24

2.18 ± 0.27
17.61 ± 10.55

2.21 ± 0.25
17.63 ± 10.33

SCV(m/s)

51.43 ± 4.73

51.91 ± 5.23

51.65 ± 4.94

0.29
p=0.9
9
p=0.6
3

Table 3.15. F-wave valuebefore treatment
Treatment
Control group
Total (n=99)
group (n=54)
(n=45)
Comparative criteria
( ± SD)
(± SD)

( ± SD)
F-wave of
Fmean(ms
26.11 ± 2.13
26.43 ± 2.56
26.26 ± 2.33
median
)
nerve –
F-fre (%)
64.39 ± 24.98
63.49 ± 20.72
63.98 ± 23.03
Right arm
F-wave of
Fmean(ms
26.21 ± 2.36
26.57 ± 3.15
26.38 ± 2.74
ulnar nerve )
– Right
F-fre (%)
63.61 ± 25.08
66.82 ± 20.87
65.07 ± 23.21
arm
F-wave of
Fmean(ms
26.22 ± 6.75
25.74 ± 2.47

26.00 ± 5.24
median
)
nerve –
F-fre (%)
58.07 ± 25.30
62.07 ± 21.39
59.89 ± 23.57
Left arm
F-wave of
Fmean(ms
26.16 ± 2.22
26.38 ± 3.04
26.26 ± 2.61
ulnar nerve )
– Left arm
F-fre (%)
59.39 ± 22.28
61.96 ± 19.91
60.56 ± 21.17
3.3.2. MRI film characteristics
Table 3.20. Severity of herniation on MRI film
Group

Treatment
group (n=54)

Control
group (n=45)

Total
(n=99)

p
0.5
0.85
0.52
0.5
0.65
0.40
0.68
0.55

p


Severity of
herniation
Disc protrusion
Disc herniation

n

%

n

%

n

%

2
3.70
1
2.22
3
3.03
1
52
96.30
44
97.78
96
96.97
1
Table 3.23. Types of herniation on MRI film
Treatment
Control group
Total
Group
group
(n=45)
(n=99)
p
(n=54)
Position of herniation
n
%

n
%
n
%
Central
10 66.67
8
80.00
18
72.0
Right paracentral disc
4
2
13.33
2
20.00
16.0
C3- protrusion
0.31
C4
Left paracentral disc
3
3
20.00
0
0
protrusion
12.0
Total
15

100
10
100
25
100.0
Central
18 64.29
14
53.85
32
59.26
Right paracentral disc
3
10.71
7
26.92
10
18.52
C4- protrusion
0.31
C5
Left paracentral disc
7
25.00
5
19.23
12
22.22
protrusion
Total

28
100
26
100
54
100.0
Central
17 40.48
19
51.35 36
45.57
Right paracentral disc
12 28.57
6
16.22 18
22.78
C5- protrusion
0.4
C6
Left paracentral disc
13 30.95
12
32.43 25
31.65
protrusion
Total
42
100
37
100

79
100.0
Central
5
45.46
9
60.0
14
53.85
Right paracentral disc
3
27.27
2
13.33
5
19.23
C6- protrusion
0.64
C7
Left paracentral disc
3
27.27
4
26.67
7
26.92
protrusion
Total
11
100

15
100
26
100.0
Table 3.25. Evaluation criteria on MRI film
Treatment group
Control group
Comparative criteria
p
(n=54) (± SD)
(n=45)( ± SD)
Torg ratio
55.13 ± 14.23
58.02 ± 18.76
p= 0.39


Anteroposterior compression
38.70 ± 8.24
41.93 ± 8.46
p=0.06
ratio (APCR)
Segmental Stenotic Index (SSI)
75.33 ± 10.59
79.51 ± 11.54
p=0.06
Degree of nerve compression
2.87 ± 0.80
2.84 ± 0.93
p=0.88

3.3.3. The relationship between several clinical characteristics and
MRI film in the treatment group before treatment
3.4. Treatment results
3.4.1. 2 weeks after the treatment
Table 3.29. Changes in clinical criteria2 weeks after the treatment
Treatment group
Control group
Criteria
p
(n=54) (± SD)
(n=45) ( ± SD)
Before treatment
6.3 ± 1.5
5.73 ± 1.48
0.07
Visual
(1)
analogue scale
After treatment(2)
2.76 ± 1.1
3.31 ± 1.29
0.02
VAS
p (1.2)
< 0.001
Before treatment
4.5 ± 0.77
4.6 ± 0.65
0.5
(1)

Muscle
strength score
After treatment(2)
4.69 ± 0.54
4.64 ± 0.57
0.72
p(1.2)
0.001
Before treatment
28.19 ± 6.04
25.84 ± 5.65
0.05
(1)
Neck disability After treatment(2)
16.44 ± 4.73
18.87 ± 5.82
0.02
index NDI
4
p(1.2)
< 0.001
Table 3.31. Characteristics of MRI film of treatment group2 weeks
after the treatment
Group
Before
2 weeks after
p
treatment (
the treatment
Comparative criteria

( ±SD)
±SD)
Torg ratio (n=50)
54.2 ± 14.07
54.8 ± 14.11
0.108
APCR (n=50)

38.42 ± 8.18

39.16 ± 8.32

0.003

SSI (n=50)

74.72 ± 10.65

74.86 ± 10.14

0.82

Degree of nerve
2.92 ± 0.78
2.78 ± 0.76
0.007
compression (n=50)
Table 3.33. F-wave values of treatment group2 weeks after the

treatment
Comparative criteria
F-wave of
median nerve
– Right arm
F-wave of
ulnar nerve –
Right arm
F-wave of
median nerve
– Left arm
F-wave of
ulnar nerve –
Left arm

Fmean(ms
)
F-fre (%)
Fmean(ms
)
F-fre (%)
Fmean(ms
)
F-fre (%)
Fmean(ms
)
F-fre (%)

26.11 ± 2.13

After
treatment
(n=45)( ±
SD)
25.87 ± 2.13

0.14

64.39 ± 24.98
26.21 ± 2.36

66.09 ± 19.39
25.55 ± 3.83

0.015
0.12

63.61 ± 25.08
26.22 ± 6.75

71.39 ± 20.48
25.55 ± 1.89

0.007
0.46

58.07 ± 25.30
26.16 ± 2.22

65.02 ± 18.36

25.85 ± 2.15

0.014
0.053

59.39 ± 22.28

68.15 ± 19.53

0.001

Before
treatment
(n=54)(± SD)

p

Table 3.35. Motor conduction velocity before and after the treatment
in treatment group
Before
After treatment
treatment
(n=54)
Comparative criteria
p
(n=54)
( ± SD)
(± SD)
Motor
DML (ms)

3.78 ± 0.73
3.61 ± 0.54
0.05
conduction
MAw (mV)
7.6 ± 4.71
7.41 ± 3.56
0.51
velocity of
MAe (mV)
6.69 ± 3.92
6.62 ± 3.13
0.82
median
MCV (m/s)
55.84 ± 4.68
56.81 ± 4.51
0.05
nerve –
Right arm
Motor
DML (ms)
2.77 ± 0.77
2.61 ± 0.47
0.05
conduction
MAw (mV)
4.55 ± 2.78
4.17 ± 2.44
0.09

velocity of
MAe (mV)
4.05 ± 2.65
3.67 ± 2.4
0.08
ulnar nerve – MCV (m/s)
57.76 ± 6.18
59.11 ± 4.63
0.07
Right arm
Motor
DML (ms)
3.73 ± 1.03
3.66 ± 0.46
0.05
conduction
MAw (mV)
6.94 ± 4.56
7.04 ± 3.59
0.76


velocity of
MAe (mV)
6.15 ± 4.13
6.39 ± 3.23
median
MCV (m/s)
57.26 ± 6.7
57.66 ± 4.18

nerve – Left
arm
Motor
DML (ms)
2.88 ± 1.29
2.69 ± 0.41
conduction
MAw (mV)
4.18 ± 2.32
4.18 ± 2.29
velocity of
MAe (mV)
3.61 ± 1.89
3.71 ± 2.01
ulnar nerve – MCV (m/s)
58.78 ± 5.57
59.33 ± 5.46
Left arm
Table 3.37. Sensoryconduction velocity before and after the
treatment in treatment group
Before treatment
After treatment
(n=54)
(n=54)
Comparative criteria
(± SD)
( ± SD)
Sensory
DSL (ms)
2.79 ± 0.33

2.72 ± 0.33
conduction
SA (μV)
17.28 ± 9.5
19.18 ± 9.82
velocity of
SCV(m/s)
49.41 ± 6.41
50.32 ± 6.24
median nerve –
Right arm
Sensory
DSL (ms)
2.3 ± 0.24
2.27 ± 0.22
conduction
SA (μV)
14.15 ± 9.31
14.79 ± 9.40
velocity of ulnar SCV(m/s)
51.02 ± 4.71
52.04 ± 5.17
nerve – Right
arm
Sensory
DSL (ms)
2.77 ± 0.35
2.7 ± 0.34
conduction
SA (μV)

22.64 ± 12.28
23.25 ± 11.32
velocity of
SCV(m/s)
49.91 ± 6.24
50.81 ± 6.22
median nerve –
Left arm
Sensory
DSL (ms)
2.23 ± 0.24
2.29 ± 0.23
conduction
SA (μV)
17.64 ± 10.24
18.05 ± 11.28
velocity of ulnar SCV(m/s)
51.43 ± 4.73
51.78 ± 4.88
nerve – Left arm

0.54
0.61
0.05
0.99
0.63
0.49

p
0.05

0.07
0.05
0.25
0.52
0.06
0.05
0.05
0.05
0.05
0.71
0.05

Table 3.38. Degree of improvement in clinical symptoms in general
Group
Treatment
Control
Total
p
Degree
group
group (n=45)
(n=99)


(n=54)
Good+Very good
Moderate
Bad
Total

n
49
5
0
54

%
90.74
9.26
0
100

n
25
17
3
45

%
55.56
37.77
6.67
100

n
74
22
3
99

%
74.75
22.22
3.03
100

< 0.001

3.4.2. Treatment results after 6 months
Table 3.39.Several clinical characteristics and MRI film 6 months
after the treatment
Group
Before
6 months after
treatment
the treatment
Comparative criteria
( ±SD)
( ±SD)
Visual analogue scale (n=31)
6.81 ± 1.85
0.81 ± 0.95
Muscle strength score(n=31)
4.39 ± 0.84
4.87 ± 0.34
Neck disability index (n=31)
29.9 ± 6.57
8.1 ± 4.17
TORG ratio(n=31)
53.58 ± 14.65

55.52 ± 15.38
APCR(n=31)
37.0 ± 8.71
39.39 ± 8.79
SSI(n=31)
71.81 ± 10.84
73.39 ± 10.47
Degree of nerve compression (n=31)
2.87 ± 0.76
2.48 ± 0.77
Table 3.40. F-wave value of treatment group6 months after the
treatment
Comparative criteria
Before treatment
After treatment
(n=31)
(n=31)
(± SD)
( ± SD)
F-wave of
Fmean(ms
26.11 ± 2.22
25.75 ± 1.88
median nerve
)
– Right arm
F-fre (%)
64.35 ± 23.47
77.03 ± 15.07
F-wave of

Fmean(ms
26.54 ± 2.31
26.71 ± 5.9
ulnar nerve –
)
Right arm
F-fre (%)
60.61 ± 27.47
83.19 ± 11.83
F-wave of
Fmean(ms
26.0 ± 2.2
25.3 ± 2.03
median nerve
)
– Left arm
F-fre (%)
53.16 ± 23.66
70.74 ± 18.76
F-wave of
Fmean(ms
26.29 ± 2.3
25.6 ± 2.29
ulnar nerve –
)

p
< 0.001
< 0.001
< 0.001

0.005
0.001
0.06
0.001
p
< 0.001
0.001
0.17
< 0.001
0.05
0.04
< 0.001


Left arm

F-fre (%)
56.42 ± 23.36
76.71 ± 16.18
0.001
Table 3.41. Motor conduction velocity before and 6 months after the
treatment
Before
After treatment
treatment
(n=31)
Comparative criteria
p
(n=31)
( ± SD)

(± SD)
Motor
DML (ms)
3.78 ± 0.59
3.73 ± 0.51
0.07
conduction
MAw (mV)
6.51 ± 2.42
6.62 ± 2.26
0.74
velocity of
MAe (mV)
6.06 ± 2.13
5.86 ± 1.71
0.54
median
MCV (m/s)
56.7 ± 4.18
56.75 ± 3.76
0.95
nerve –
Right arm
Motor
DML (ms)
2.70 ± 0.43
2.64 ± 0.24
0.11
conduction
MAw (mV)

3.98 ± 2.16
4.07 ± 2.50
0.76
velocity of
MAe (mV)
3.61 ± 2.07
3.64 ± 2.5
0.92
ulnar nerve – MCV (m/s)
57.81 ± 7.48
60.68 ± 4.06
0.06
Right arm
Motor
DML (ms)
3.8 ± 1.07
3.59 ± 0.58
0.19
conduction
MAw (mV)
5.53 ± 2.32
6.18 ± 2.4
0.05
velocity of
MAe (mV)
5.11 ± 2.2
5.64 ± 1.86
0.08
median
MCV (m/s)

58.23 ± 7.76
57.3 ± 4.10
0.53
nerve – Left
arm
Motor
DML (ms)
2.71 ± 0.56
2.64 ± 0.25
0.14
conduction
MAw (mV)
3.79 ± 1.54
3.68 ± 1.46
0.69
velocity of
MAe (mV)
3.39 ± 1.43
3.05 ± 1.33
0.13
ulnar nerve – MCV (m/s)
58.65 ± 6.26
59.95 ± 3.7
0.27
Left arm
Table 3.42. Sensory conduction velocity before and 6 months after the
treatment
Before treatment
After treatment
Comparative criteria

p
(n=31) (± SD)
(n=31) ( ± SD)
Sensory
DSL (ms)
2.82 ± 0.33
2.77 ± 0.35
0.0
conduction
6
velocity of median SA (μV)
18.11 ± 8.7
21.81 ± 11.37
0.0
nerve – Right arm
8


Sensory
conduction
velocity of ulnar
nerve – Right arm
Sensory
conduction
velocity of median
nerve – Left arm
Sensory
conduction
velocity of ulnar
nerve – Left arm

SCV(m/s
)
DSL (ms)

49.3 ± 6.46

50.34 ± 10.45

2.34 ± 0.24

2.31 ± 0.25

SA (μV)

14.79 ± 9.27

18.04 ± 10.13

SCV
(m/s)
DSL (ms)

51.33 ± 4.55

52.82 ± 4.04

2.82 ± 0.35

2.84 ± 0.27

SA (μV)

22.85 ± 12.08

24.58 ± 11.25

SCV
(m/s)
DSL (ms)

51.93 ± 6.19

52.84 ± 4.92

2.26 ± 0.22

2.25 ± 0.23

SA (μV)

19.69 ± 10.67

22.38 ± 11.3

SCV
(m/s)

52.17 ± 4.13

52.25 ± 4.4

Figure 3.11. The degree of improvements in clinical symptoms in
general after 6 months
CHAPTER 4
DISCUSSION
4.1. General characteristics of treatment and control group
4.2. Clinical and neurotransmission characteristics and MRI film
of both groups
4.2.1. Clinical characteristics
4.2.1.4. Clinical characteristics
In our study, 98.99% of patients experienced cervical spine
syndrome; 77.78% had signs of nerve root compression syndrome;
26.26% suffered from dysautonomia. Other symptoms were less
frequent. There was no statistically significant difference between the
two groups.

0.5
1
0.0
5
0.0
6
0.11
0.1
4
0.2
4
0.1
7

0.3
3
0.1
8
0.2
3


Cervical spine syndrome
In our study, 98.99% of patients had signs of cervical spine
syndrome (such as pain in cervical spine, spasticity of cervical spine,
limited mobility of cervical spine). Pain and spasticity of cervical
spine were the most common and earliest syndrome in both groups,
accounting for 100% of patients in the treatment group and 97.78%
in the control group, the difference was not statistically significant
between the two groups.
Nerve root compression syndrome
The common sign of nerve root compression syndrome was
nerve root paraesthesia (75.76%); upper limb numbness (77.78%),
decreased pain during spinal traction (77.78%); Spurling’s sign
(57.58%); cervical nerve root motor disorder (19.19%); cervical
nerve root sensory disorder (49.49%).
Cervical cord compression syndrome
In our study, the proportion of patients presenting with
cervical cord compression syndrome was not much. Several signs of
of simple cervical cord compression syndrome: increased tendon
reflexes, Hoffmann’s sign and hypoesthesia below damaged level
(together accounted for 9.09%). Other signs were less prevalent.
In addition, we also encountered the signs of dysautonomia
and vertebrobasilar insufficiency syndrome in the treatment group,

with the most common signs were occipital headache (30.30%),
dizziness when changing positions (27.27%); systemic vertigo
(23.23%).
4.2.1.5. Visual analogue scale, muscle strength score and neck
disability index before treatment
In our study, when assessing the pain level on VAS, the
results showed the proportion of severe pain level or worse accounted
for 63.64%. Average pain score was 6.04 ± 1.51.


Muscle strength scale before treatment: 88.89% of patients
had muscle strength scores of 4-5 points. Average muscular strength
score was 4.55 ± 0.72. There were no cases of complete paralysis in
either group.
Neck disability index: assessed the degree of improvement in
cervical spine function based on the NDI. In our study, the functional
score in treatment group was 28.19 ± 6.04, which was higher than
that of control group 25.84 ± 5.65 (p = 0.05).
4.2.2. Nerve conduction studies characteristics
Distal Motor Latency – DML and Motor Conduction
Velocity – MCV
In our study, the median nerve’s DML of right and left arm
was 3.69 ± 0.66 and 3.63 ± 0.83 ms, respectively. The ulnar nerve’s
DML of right and left arm was is 2.68 ± 0.68 and 2.79 ± 1.09 ms,
respectively.
In our study, the median nerve’s MCV of right and left arm
was 55.95 ± 4.37 and 57.17 ± 5.82 ms, respectively. The ulnar
nerve’s MCV of right and left arm was is 57.76 ± 5.72 and 58.33 ±
5.13 ms, respectively.
The results of our study showed the distal motor latency

(DML) and the motor conduction velocity (MCV) of both median
and ulnar nerve in right and left arms were not different. DML and
MCV values of both groups were equivalent to normal values
Sensory Conduction Velocity - SCV
Similar to the motor conduction velocity measurement, our
results showed the distal sensory latency (DSL) and sensory
conduction velocity (SCV) in both median and ulnar nerve in right
and left arms had no difference. However, both DSL and SCV values
were equivalent to normal values.


Apart from that, our results showed there was no
difference between the treatmentand control group on
the value of F-wave inboth median and ulnar nerve in
right and left arms.
4.2.3. Characteristics of MRI results
4.2.3.1. Position of herniation
Based on our analysis of MRI film, we found the proportion
of herniation in C5-C6 segment was the highest at 77.78%; followed
by C4 - C5 segmentaccounting for 52.53%. Other positions were
encountered with lesser proportions.
4.2.3.2. Classifications of disc herniation
In our study, the single disc herniation accounted for 38.38%;
multiple disc (2-4) herniation accounted for 61.62%. 100% of
patients in both groups had posterior herniated disc.
The axial plane showed that: at all position of herniation, the
central form of herniation always prevailed (72%, 59.26%, 45.57%
and 53.85% in the C3-C4, C4-C5, C5-C6 and C6-C7 segment,
respectively) followed by the form of left paracentral disc protrusion.
There was no difference in type of herniation between the treatment

and control groups
4.2.3.3. Degree of nerve compression in MRI film
In this study, we assessed the degree of nerve compression
based on 4 indicators on MRI film:
- Torg ratio: Our results showed the Torg ratio in the
treatment group was 55.13 ± 14.23 while that of the control group
was 58.02 ± 18.76, before the treatment.
- Anteroposterior compression ratio (APCR):Our results
showed the APCR in the treatmentand control group was 38.70 ± 8.24
and 41.93 ± 8.46, respectively, before the treatment.
- Segmental Stenotic Index (SSI): Our results showed the SSI
in the treatment and control group was 75.33 ± 10.59 and 79.51 ±
11.54, respectively, before the treatment.
In this study, we further determined the degree of nerve
compression by Prof. Dr. Nguyen Van Chuong. The results showed


the average "degree of nerve compression" in the treatment and
control group was 2.87 ± 0.80 and 2.84 ± 0.93, respectively, before
the treatment.
4.3. The effectiveness of cervical disc herniation treatmentby
inflatable traction method in combination with conservative
treatment regimen
4.3.1. Clinical characteristics after the treatment
- The VAS score in the treatment and control group was not
statisticallysignificant before treatment, but became lower in the
treatment group than the control group and statistically significant 2
weeks after the treatment (p = 0.02). The average VAS score of the
treatment group after the treatment was 2.76 ± 1.1, which was lower
than before the treatment 6.3 ± 1.5 (p <0.001). 6 months after the

treatment, the VAS scoreof the treatment group was 0.81 ± 0.95 and
decreased significantly compared to before the treatment (p <0.001)
- The average muscle strength score in the treatment group
after the treatment was 4.69 ± 0.54, higher than before the treatment
4.5 ± 0.77 (p = 0.001). 6 months after the treatment, the muscle
strength score increased to 4.87 ± 0.34 (p <0.001)
- The difference between the NDI before the treatment in the
treatment and control group was not statistically significant.
However, 2 weeks after the treatment, the NDI of the treatment group
was significantly lower than that of the control group. The average
NDI score in the treatment group was 16.44 ± 4.73 after the treatment
and lower than before treatment 28.19 ± 6.04 (p <0.001). 6 months
after the treatment, the NDI reduced to 8.1 ± 4.17 and there was a
significant difference compared to before the treatment (p <0.001)
4.3.2. Nerve conduction studies characteristics
after the treatment
- There was no difference between the treatment and control
group regarding the value of F-wave of both median and ulnar nerve
in right and left arms 2 weeks after the treatment. The F-fre (%) value
in the treatment group 2 weeks after treatment increased compared to
before the treatment (p <0.05). The F-fre (%)6 months after the
treatment increased significantly compared to before the treatment (p
<0.001).
- There was no difference in sensory and motor conduction
velocity 2 weeks after the treatment in the treatment and control


groups. The change of motor and sensory conduction velocity in the
treatment group before and after the treatment (2 weeks or 6 months)
was not statistically significant.

4.3.3. Characteristics of MRI film before the treatment
2 weeks after the treatment, on the MRI film, we found the
average ratio of APCR increased (p = 0.003) and the average degree
of nerve compression decreased compared to before the treatment (p
= 0.007). But there was no difference in some characteristics of MRI
film between the treatment and control group 2 weeks after the
treatment. 6 months after the treatment, the TORG and APCR ratio
increased, while the average degree of nerve compression decreased
compared to before the treatment. These changes were statistically
significant with p <0.05. In comparison with before the treatment, the
SSI scores increased 2 weeks and 6 months after treatment, but the
difference was not statistically significant.
4.3.4. The degree of improvements in clinical symptoms in general
90.74% of patients in the treatment group experienced
improvement of symptoms, 55.56% higher than the control group.
The difference was statistically significant (p <0.001). 6 months after
the treatment, 100% of the patients in the treatment group
experienced improvement of symptoms, with up to 87% of which had
very good improvements.
In our study, there were no cases of complications that
occurred when the cervical traction treatment was performed.
CONCLUSION
Through our study of two groups of 99 patients with cervical disc
herniation, the treatment group (54 patients) was treated with
inflatable cervical traction device in combination with conservative
treatment regimenand the control group (45 patients) was treated by
conservative treatment regimen only. We concluded that:
1. Comment on clinical characteristics, MRI films and
several neurotransmission indicators in patients with cervical
disc herniation

-Clinical characteristics
+ The most common age of this disease was 40-59,
accounting for 67.68%. Average age was 51.85 ± 9.94. Women
accounted for 59.60%.