Cervical Stenosis with Myleopathy

F. Treatments
F.1. In conventional Medicine perspective
I. Non surgical treatments
1.1. Wait and watch
Wait and watch may be necessary if patients are experience no symptom and abnormalities but diagnosed with the diseases as some of these patients may not develop any problem in the future.

1.2. Medication
Certain medication such as non-steroidal anti-inflammatory drugs (NSAIDs), oral steroids, or injected steroids such as epidural steroid injections and nerve root injections may be helpful in relieving pain and alleviating symptoms temporary of the patients with no intention to correct any abnormalities or malalignment.

1.3. Physical therapy or exercise
Physical exercise such as stretching may be helpful to restore the flexibility of tight muscles
as well as enhancing the neck mobility, muscular strength and spinal balance. Other exercise, including Cardiovascular exercises for arms and legs also to promote the circulation of blood.

1.4. Etc.

2. Surgical treatments
Surgical treatments may be necessary if patients are experience the symptoms of increasing weakness, pain or inability to walk, etc. depending to differentiation
2.1. Anterior Surgery
Cervical Discectomy and Fusion (ACDF)
The aim of the surgery is to relieve pressure from the spinal cord and compression of the spinal. Anterior Cervical Discectomy and Fusion (ACDF) is the operation done from the front of the neck to remove the disc above and below the vertebra and replace it with a small plug of bone. If more than one level
of the spine is involved, Cervical Spinal Fusion may be necessary by implanting a bone graft between cervical segments to support the spine as to compensate for the removal of bone and discs.

2.2. Posterior surgery
a. Laminectomy and Fusion
The aim of the surgery is also to relieve the pressure and to create more space for the nerves. In Laminectomy and Fusion, the lamina is removed and two or more vertebral segments of the cervical spine are fused together.

b. Laminoplasty
In case of Laminoplasty, only a small section of the bony roof of the spine, the lamina, is moved instead of removal of the lamina to expand the spinal canal with an aim to create a space for the the spinal cord.

2.3.  Etc.

F.2. In herbal medicine perspective
The aim of herbal medicine is to relieve symptoms of Cervical Stenosis
1. Cayenne is also known as Cayenne Pepper, a red, hot chili pepper, belonging to Capsicum annuum, the family Solanaceae, native to sub-tropical and tropical regions. It has been used in traditional medicine to increases metabolism, enhance circulatory system and stomach and the intestinal tract, adjust blood pressure, lower LDL cholesterol and triglycerides, treat frostbite, muscles, arthritis, rheumatism, low back pain, strains, sprains, bruises and neuralgia, etc.
the non-pungent pepper CH-19 Sweet and of hot red pepper activates the sympathetic nervous system (SNS) and enhances thermogenesis as effectively as hot red pepper, ant that the heat loss effect due to CH-19 Sweet is weaker than that due to hot red pepper. Furthermore, we found that intake of CH-19 Sweet does not affect systolic BP or HR, while hot red pepper transiently elevates them, according to the study of "Effects of CH-19 Sweet, a non-pungent cultivar of red pepper, on sympathetic nervous activity, body temperature, heart rate, and blood pressure in humans" by Hachiya S, Kawabata F, Ohnuki K, Inoue N, Yoneda H, Yazawa S, Fushiki T.(a)

2. Valerian is a perennial flowering plant, in the genus Valeriana, belonging to the family Valerianaceae, native to Europe and parts of Asia. The herb has been used as a sedative and relaxing agent and to treat the liver, the urinary tract, the digestive tract problem, nerve conditions, etc.
In the evaluation of the effect of V. wallichii chemotype (patchouli alcohol) extract (DCME) and essential oil (VPAEO) on experimental models of nociception and to elucidate its possible mechanism of action, found that DCME and VPAEO (40 and 80 mg/kg, p.o.) significantly inhibited the number of writhings as compared to vehicle treated group. None of the doses of DCME and VPAEO exhibited any effect in tail flick model suggesting only peripheral analgesic activity. When studied for mechanism of action in acetic acid induced writhing, subeffective dose of essential oil significantly potentiated the effect of aspirin while no potentiation was seen in case of extract. These data suggest that essential oil VPAEO exerted peripheral analgesic via inhibition of prostaglandin synthesis, accoridng to "Elucidation of possible mechanism of analgesic action of Valeriana wallichii DC chemotype (patchouli alcohol) in experimental animal models" by Sah SP, Mathela CS, Chopra K.(b)

3. Harpagophytum procumbens (Devil's claw), Salix alba (White willow bark), and Capsicum frutescens (Cayenne)
In a systematic review of randomized controlled trials to determine the effectiveness of herbal medicine compared with placebo, no intervention, or "standard/accepted/conventional treatments" for nonspecific low back pain, found that Harpagophytum procumbens (Devil's claw), Salix alba (White willow bark), and Capsicum frutescens (Cayenne) seem to reduce pain more than placebo. Additional trials testing these herbal medicines against standard treatments will clarify their equivalence in terms of efficacy(c).

4. Etc. 

F.3. In Chinese medicine perspective
1. Compound Qishe Tablets, Jingfukang, Extractum Nucis Vomicae, etc.
In the review of randomized controlled trials with adults with a clinical diagnosis of cervical degenerative disc disease, cervical radiculopathy or myelopathy supported by appropriate radiological findings. ll four included studies were in Chinese; two of which were unpublished. Effect sizes were not clinically relevant and there was low quality evidence for all outcomes due to study limitations and sparse data (single studies). Two trials (680 participants) found that Compound Qishe Tablets relieved pain better in the short-term than either placebo or Jingfukang; one trial (60 participants) found than an oral herbal formula of Huangqi ((Radix Astragali)18 g, Dangshen (Radix Codonopsis) 9 g, Sanqi (Radix Notoginseng) 9 g, Chuanxiong (Rhizoma Chuanxiong)12 g, Lujiao (Cornu Cervi Pantotrichum) 12 g, and Zhimu (Rhizoma Anemarrhenae)12 g) relieved pain better than Mobicox or Methycobal and one trial (360 participants) showed that a topical herbal medicine, Compound Extractum Nucis Vomicae, relieved pain better than Diclofenac Diethylamine Emulgel.

2. Acupuncture
According to the study of Witzmann A at the Neurochirurgischen Abteilung des Landeskrankenhauses Feldkirch., the treatment of chronic spinal pain is dominated by non-operative procedures. There are three main procedures in this field of treatment: the manual medicine, the therapeutic application of local anesthetics and acupuncture. Acupuncture is the last step of the treatment cascade in out patients in any case, because acupuncture does not only serve as treatment option for pain relief, but also and even more so has an harmonizing effect upon physical and psychological disturbances. It is absolutely necessary for the patient to lie down for 25 to 30 minutes to reach these goals(2).

3. Etc.

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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/17341828
(b) http://www.ncbi.nlm.nih.gov/pubmed/21046983 
(c) http://www.ncbi.nlm.nih.gov/pubmed/17202897
(1) http://www.ncbi.nlm.nih.gov/pubmed/20091597 
(2) http://www.ncbi.nlm.nih.gov/pubmed/11075429