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TITLE OF CASE

Successful standalone ayurvedic management of Cervical canal stenosis- A case report 

Dr Rajnikanth 

ABSTRACT

A 40-year-old male patient presented with neck pain and radicular pain in left upper arm since 1 month associated with tingling and numbness of fingers and giddiness. The patient had a history of Road traffic accident 1 month back. He had consulted an Allopathic doctor. Neurological exam and X Ray of the spine was normal and only analgesics were prescribed. When the symptoms relapsed, MRI done revealed C5-C6, C6, C7 PIVD with root compression. The biomedical diagnosis was confirmed as Cervical canal stenosis, and surgery was recommended. The patient refused and consulted Dr Rajnikanth for Ayurvedic management. The ayurvedic diagnosis was Abhighataja griva gata vayu vruddhi. The line of treatment followed was to pacify the vata and initiate the sandhana karma. The treatment also targeted to address the avarana of vata and do rasayana for the asthi dhatu. After 1 month of treatment, there was significant reduction in neck pain and giddiness. Radicular pain was absent. The Neck Pain And Disability (NPAD) score that was recorded as 87 before treatment became 10 after treatment. This case report demonstrates the successful standalone ayurvedic management of cervical canal stenosis, in a patient who was suggested surgery as the best option. 

KEYWORDS

Cervical, stenosis, abhighataja, griva, vayu gata, vata, case report 

INTRODUCTION

The word ‘stenosis’ means ‘narrowing of the passage in the body’. When the cervical spine is affected, then it is called as Cervical spine stenosis, or the cervical canal stenosis. Spinal stenosis that occurs in the part of the spine that’s in your neck is called cervical spinal stenosis. The causes can be a number of contributing factors like Osteoarthritis, Rheumatoid arthritis, Diffuse idiopathic skeletal hyperostosis (DISH), Cartilage loss, Slipped or  herniated disk, Thickened ligaments, Spinal injuries, Tumors on or near the spine. 

The general Symptoms are Neck pain, Pain in one or both arms, A feeling of electrical charge or tingling sensation that shoots down the back when you move your head,  and numbness in your arms or hands.

Diagnostic criteria: Medical history and clinical evaluation is the basis of the diagnosis. Apart from this, EMG, Imaging tests like MRI, X Ray or CT Scan may be done, to measure the muscle response or to check if the compression is happening in the spine or within an extremity. 

Treatment:The severity of the stenosis, as well as the symptoms, will determine the type of treatment that a doctor suggests. The treatment plan will likely include a variety of approaches, both at home and with a physical therapist. In some cases, surgery may be needed, but it’s not usually the first option. 

A doctor may recommend: Medications, Physical therapy, and Epidurals. 

Surgery options for cervical spinal stenosis: In more severe cases, a doctor might suggest surgery to create some extra space in the spinal canal to lessen the pressure and the pain. Some of the surgical procedures are as follows:  

Anterior cervical discectomy and fusion. 

Cervical laminoplasty.  

Posterior laminectomy and fusion. 

Disc replacement.

Exercises like cervical flexion and rotation, side bend, chin tuck, median nerve slider and shoulder shrugs are suggested to be done at home. 

Prognosis: Most people with cervical spinal stenosis have mild cases or symptoms and don’t have to adjust their lives much to accommodate the condition. In fact, many people find that their pain doesn’t necessarily get progressively worse over time, and they can manage their pain and symptoms. However, for some people, the condition goes get worse as time goes by. They may develop more serious symptoms, such as loss of bowel or bladder function and trouble walking. This is more likely to happen to people who have cervical stenosis with myelopathy.

PATIENT INFORMATION

In this case report, a 40-year-old male patient presented with neck pain and radicular pain in left upper arm since 1 month associated with tingling and numbness of fingers and giddiness. The patient had a history of Road traffic accident 1 month back. He had consulted an Allopathic doctor. Neurological exam and X Ray of the spine was normal and only analgesics were prescribed. When the symptoms relapsed, MRI done revealed C5-C6, C6, C7 PIVD with root compression. The biomedical diagnosis was confirmed as Cervical canal stenosis, and surgery was recommended. The patient refused and consulted Dr Rajnikanth for Ayurvedic management. 

No relevant Family/Surgical/Genetic History.

Psychosocial history: Sleep is disturbed due to the pain

Addictions- None

CLINICAL FINDINGS

General examination and systemic examinations done. 

On examination:
No swelling , tenderness
ROM:
Flexion- Pain+
Extension- Pain+
Hyposensitivity at C7, C8
 

TIMELINE

Image 1. Timeline of events added below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter: The biomedical diagnosis was confirmed as Cervical canal stenosis based on the MRI reports and neurological examination.

Image 2.  The Neck Pain and Disability Scale (NPAD) at baseline

 

Image 3. MRI study of Cervical spine dated 12.7.2023

Image 4. Diagnosis proof document dated 13.7.2023

Ayurvedic Assessment was done based on the presenting complaints and clinical evaluation. The treating physician confirmed the Ayurvedic diagnosis as Abhighataja griva gata vayu vriddhi. 

Baseline evaluation 

Differential Diagnosis- 

Ankylosing spondylitis

epidural, subdural, or intradural abscess

conversion disorder

rheumatoid arthritis

Diffuse idiopathic skeletal hyperostosis (DISH)
Based on previous treatment records and clinical findings, the physician clinically confirmed the diagnosis as cervical canal stenosis. 

Prognosis: Cervical canal stenosis may lead to serious symptoms such as major body weakness and paralysis. For those with myelopathy, surgical decompression can provide some relief from pain and sensory loss and can prevent the exacerbation of myelopathy. In this case, the patient was advised for surgical management. With Ayurvedic treatment, patient  attained a significant relief from all the symptoms and could avoid the surgical management. 

THERAPEUTIC INTERVENTION

Refer the tab ‘Treatment’ in the Portal. 

FOLLOW-UP AND OUTCOMES

The patient had 3 follow ups in total. The subjective and objective parameters were the primary assessment modality. 

Clinician-based assessment; The symptoms were assessed every follow up. 

Table 1. Symptoms assessed date wise

TIMELINE	SYMPTOMS
AFTER 1 WEEK (25.7.2023)	Significant reduction in giddiness & radicular pain
AFTER 1 MONTH (16.8.2023)	Giddiness & radicular pain further reduced
AFTER 1 MONTH AND 3 WEEKS (6.9.2023)	Giddiness- absent: radicular pain in neck absent: neck pain- mild

Objective parameters: The NPAD was documented at endpoint 

Image 5. NPAD documented at endpoint

Patient-assessed; Not applicable

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well. 

Method of assessment- Subjective and objective parameters were the primary assessment criteria used. 

Adverse and unanticipated events; None reported

DISCUSSION: 

Cervical canal stenosis may lead to serious symptoms such as major body weakness and paralysis. In this patient, surgery was suggested as the primary choice of treatment. Bu the patient was not willing and opted for Ayurveda. The Ayurvedic diagnosis was Abhighataja griva gata vayu vriddhi and the rationale of treatment was explained by the treating physician as follows:

Table 2. Medicines/Therapies and the rationale 

 

Name of the medicine/ Procedure	Rationale
Dhanyamladhara and Upnaha sweda	To reduce vayu locally.
Nasya with Karpasastyadi taila	To reduce vayu.
Sandhaniya maha Kashaya tablet	To do sandhana karma in spinal cord.
Gandha tailam capsule	To do sandhana karma in spinal cord.
Nasya with Ksheerbala 101 avarti	To control vayu in the neck.
Shuddha guggulu tablet	To reduce vayu and its avarana.
Panchmritaloha guggulu	To strengthen spinal cord from injury.
Boniheal tablet	To strengthen asthi dhatu.
Rheumat G Tablet	Rasayana for asthi dhatu.

PATIENT’S PERSPECTIVE

Not available. 

LEARNING POINTS/TAKE HOME MESSAGES 

This case report highlights the efficacy of Ayurveda in treating cervical canal stenosis in a patient who was suggested for surgery. Ayurveda is an effective alternative or complementary treatment for cervical canal stenosis in patients, potentially avoiding the need for surgery or are not willing to undergo surgery. 

INFORMED CONSENT

Written consent obtained from patient for publishing of the case report in the Portal 

ACKNOWLEDGEMENTS

None

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE

1. https://www.healthline.com/health/bone-health/cervical-spinal-stenosis#outlook