E-ISSN:2456-3110

Case Report

Cervical Myelopathy

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 12 DECEMBER
Publisherwww.maharshicharaka.in

Ayurvedic approach to Cervical Myelopathy - A Case Report

Bekal A1*, Totad M2, Vasantha B3, Jones MT4, Kattimani AB5
DOI:10.21760/jaims.9.12.40

1* Amarnath Bekal, Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Muttappa Totad, Associate Professor, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 Vasantha B, Associate Professor, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

4 Merlyn T Jones, Postgraduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

5 Anoop B Kattimani, Postgraduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

Cervical myelopathy is a condition describing a compression of the spinal cord at the cervical level resulting in spasticity, hyperreflexia, hand clumsiness and gait disturbances. This progresses in a stepwise manner with functional decline and significant paralysis. Decompression surgery is necessary if conservative treatment fails. Sarvangavata is the one disease in Ayurveda which has the similar clinical features as myelopathy. Here is the case of 59 years old male with reduced strength in both upper and lower extremities, difficulty in getting up from lying position, standing and walking without support, difficulty in grasping and gripping objects, bladder and bowel incontinence for 6 months and was diagnosed with Cervical Myelopathy. MRI of Cervical Spine showed C4–C5 canal stenosis with myelopathy. Udwartana, Parisheka Sweda, Abhyanga, Shashtika Shali Pinda Sweda, Basti and Shamanoushadhis were given for the duration of 42 days and assessments were done on the basis of Medical Research Council (MRC) Scale for Muscle Strength, Modified Japanese Orthopaedic Association (mJOA) Score and Myelopathy Disability Index, there was marked improvement in these scales.

Keywords: Ayurveda, Basti, Panchakarma, Sarvangavata, Cervical myelopathy

Corresponding Author How to Cite this Article To Browse
Amarnath Bekal, Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Bekal A, Totad M, Vasantha B, Jones MT, Kattimani AB, Ayurvedic approach to Cervical Myelopathy - A Case Report. J Ayu Int Med Sci. 2024;9(12):295-300.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-11-12 2024-11-22 2024-12-02 2024-12-12 2024-12-24
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© 2024by Bekal A, Totad M, Vasantha B, Jones MT, Kattimani ABand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Download PDFBack To ArticleIntroductionCase ReportObservations and ResultsDiscussionConclusionReferences
Amarnath B et al. Ayurvedic approach to Cervical Myelopathy

Introduction

Cervical myelopathy is the most serious condition of cervical spondylosis and is the most commonly acquired cause of spinal cord dysfunction among those aged over 55 years.[1]

The incidence of hospitalization in eastern Asia is 4.04 per 100,000 person-years, with higher incidences observed in older and male patients.[2]

Cervical myelopathy can be appreciated after chronic compression of the spinal cord followed by weakness of limbs, reduced fine motor skills, neck pain and stiffness, intermittent shooting pain and gait disturbances. Cervical myelopathy comprises spondylosis, intervertebral disc herniation, facet arthrosis, ligamentous hypertrophy, calcification and ossification. Myelopathy occurs as a result of three important pathophysiological factors, they are static mechanical factors, dynamic mechanical factors, and spinal cord ischemia.[3]

The natural history of this disorder is usually slow deterioration in a stepwise fashion, with worsening symptoms of gait abnormalities, weakness, sensory changes in limbs and often pain. Definitive therapy consists of surgical decompression, either posterior laminectomy or an anterior approach with resection of the protruded disk and bony material, neuroplasticity and conservative management.[4]

The description of the clinical signs and symptoms of cervical myelopathy can be interpreted with Sarvangavata in Ayurveda science. Sarvangavata has been enlisted among the eighty forms of Vataja Nanatmaja Vyadhi.[5]

The symptoms of Vatavyadhi includes Sankocha (contraction), Stambhana (stiffness) and Shoola in the joints and bones, Graha (spasticity) of extremities, back as well as head, Shosha (atrophy) of body parts, Spandana (trembling of body), Gatrasuptata (numbness), Hundana (shrinking) of head, nose, eyes, clavicles region and neck, Bheda (breaking pain), Toda (pricking pain), Kampana (trembling), Balaindriyabhramsa (loss of strength and sensory function).[6]

This case report of Sarvangavata shows the successful outcome of the Ayurvedic intervention such as Nasya, Abhyanga, Swedana, Basti, Jaloukavacharana and Shamanaushadhis.

Case Report

Patient Information:

A male patient aged 59 years, k/c/o Hypertension and Type2 Diabetes Mellites Since 6 years, who was conscious and oriented to time, place and person brought in a wheelchair to Kayachikitsa OPD of Sri Dharmasthala Manjunatheshwara (SDM) College of Ayurveda and Hospital, Hassan on 03 August 2023 with the chief complaints of reduced strength in the Bilateral upper and lower limbs, difficulty in getting up from lying position, standing and walking without support, difficulty in grasping and gripping objects, bladder and bowel incontinence, slurred speech, heaviness, pain in bilateral upper and lower limbs and numbness & complete loss of sensation in the bilateral upper and lower limbs since 6 months, got admitted on the same day under IPD No:068982.

Timeline

DateRelevant medical history
May 1993Paraparesis & bladder incontinence, took treatment from Orthopedician for 1 week (details not available).
June 2005Quadriparesis associated/with pain, able to walk without support, Bladder & Bowel (B&B) incontinence.
July 2023Quadriparesis a/w pain, unable to walk without support, B&B incontinence. Consulted at Bhagwan Mahaveer Jain Hospital, Bangalore and was diagnosed as Cervical Myelopathy. Surgery: Cervical4-Cervical5 anterior cervical discectomy, decompression, adhesiolysis, neurolysis & fusion with cage, bone graft under General Anaesthesia (18/07/2023)
03/08/2023
14/09/2023		Treated at SDM, Hassan for 42 days (12 days In-patient & 30 days out-patient)

Clinical Findings

General Examination:

Built, nutritional status, hair and nail of the patient are normal, pallor, clubbing, cyanosis, icterus, lymphadenopathy and edema were absent. Blood pressure was 130/80 mm of Hg and pulse rate was 83 beats /minute.

Systemic Examination:

  • Respiratory system - on auscultation, normal bronchio vasicular sounds heard and no abnormality detected.
  • Cardiovascular system - S1 S2 heard and no abnormality detected.
  • GIT - Per abdomen was soft, nontender, no organomegaly detected.

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  • Central Nervous System - Conscious and Oriented to time, place and person,

Motor Functions

  • Muscle power
RightULProx1/5
Dist1/5
LLProx2/5
Dist2/5
LeftULProx2/5
Dist2/5
LLProx2/5
Dist2/5
  • Deep tendon reflexes: Biceps, triceps, supinator, knee jerk and ankle jerk on both sides were found to be 3+
  • Tone: Bilateral upper and lower limb was hypertonic(spastic)
  • Sensory functions: Bilateral palm and foot, fine touch - absent, crude touch - present
  • Gait - Ataxic with support
  • Hand Grip - Right:2/5 left:3/5

Investigation:

MRI of Cervical Spine: 17/07/2023: C4 - C5 disc space reduction with disc protrusion with myelopathy of cord with reduction in cervical lordosis

Treatment

DateMedication / DoseRemarks
03/08/2023-05/08/2023
(3 days)		1. Dhanvantara Vati  1 TID B/F
2. Cap. Rasaushadi Yoga 1 TID A/F
3. Naadi Kashaya  100 ml A/F
4. Sarvanga Udwartana followed by Parisheka Sweda with Dashamoola Kwatha		Lightness in the body was obtained by Rukshana & Swedana Rx
Aim: Langhana and Shrotoshodhana
06/08/2023-09/08/2023
(4 days)		1 - 3, 4. Sarvanga Abhyanga with Ksheerabala Taila f/b Dashamoola Kwatha Parisheka
6.Anuvasana Basti - Brihat Saindhavadi Taila (80ml)
10/08/2023-14/08/2023
(5 days)		1 - 4, 5. Sarvanga abhyanga with Ksheerabala Taila f/b Shashtika Shali Pinda Sweda
6. Anuvasana Basthi with Sahacharadi Taila (80ml)		Improvement in Strength was seen by Snehana & Bhrumhana Rx
15/08/2023-14/09/2023
(30 days)		Discharge Medications
1. Dhanvantara Vati  1 TID B/F
2. Cap - Rasaushadi Yoga 1 TID A/F
3. Tab - Anulomana DS  1 HS A/F

Diagnosis:

Sarvangavata - Cervical Myelopathy (C4 - C5)

Observations and Results

The condition of the patient was improved gradually along with the course of treatment. The strength and power of both left upper and lower limb was increased to 4/5 from 1/5 or 2/5, also tone of the muscle were improved and deep tendon reflex were normal after the course of treatment.

Gait before treatment was ataxic and at the time of discharge it was reduced and was able to walk without support.

Assessment Scales

MRC Muscle Strength

ParameterBTAT
RightULProx14
Dist14
LLProx24
Dist24
LeftULProx24
Dist24
LLProx24
Dist24

Modified Japanese Orthopaedic Association (MJOA) Score

AssessmentBTAT
Upper Limb Motor14
Lower Limb Motor36
Upper Limb Sensory23
Sphincter02
Total (24)615

Myelopathy Disability Index

AssessmentScore
BTAT
Rising are you able to stand up from an armless straight chair41
Rising are you able to get in and out of bed42
Eating are you able to cut your meat42
Eating are you able to lift a full cup or glass to your mouth42
Walking are you able to walk outdoors on flat ground?31
Walking are you able to climb up five steps41
Hygiene are you able to wash and dry your entire body42
Hygiene are you able to get on and off the toilet?31
Grip are you able to open jars which have been previously opened31
Activities are you able to: Get in and out of a car31
Total3614

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Muscle Tone (Modified Ashworth’s Scale)

AssessmentBTAT
Right upper limb21
Right lower limb21
Left upper limb1+1
Left lower limb1+1

Discussion

The three main pathophysiologic factors in the development of CSM are static mechanical compression, dynamic mechanical compression and spinal cord ischemia resulting in myelopathy.[7]

Vata is vitiated due to several etiological factors like Margavarana (~obstruction in natural course of Vata such as normal distribution, synthesis of tissues elements) and Dhatukshaya (~depletion of body tissue).

This vitiated Vata leads to Margavarana and Dhatukshaya in vicious cycle and may lead to manifestation of Sarvanga Vata[8] (~CSM). Bhrumhana (~nourishment) is the treatment for Dhatukshaya. Snigdha, Srotosodhana, Vatanulomana and treatment which are compatible to Kapha and Pitta Doshas should be adopted for Avarana or Margavarodha.[9]

Udwartana (~Powder massage/Rubbing):

  • Udwartana is a form of Abhyanga that is done in Pratiloma Gati (~against hair follicles). It was done with Kolakulathadi Choorna. Udwartana helped in Shrotomukha Vishodhana, removed the Gurutwa, Tandra and brought Laghuta to the body.
  • Stimulates both motor and sensory nerve endings in various parts of the body. This stimulation is carried along the sensory fibres of a nerve to the spinal cord and hence to the brain.[10]

Parisheka Sweda (~Sudation through pouring warm liquids): It is a type of Drava Sweda done with Dashamoola Kwatha. Due to the virtue of its Ushna, Rukhsa and Tridoshahara properties helped in reducing Shoola, Stabdhata which were due to vitiated Vata Dosha.[11]

Abyanga (~Oil massage): Ksheerbala Taila was used for Abhyanga. Ksheerbala Taila improved strength. It constitutes of Bala, cow milk, and sesame oil, which pacify the Vata.[12]

Shashtika Shali Pinda Sweda (~Milk and rice ball sudation):

  • This comes under category of Saagnisweda with Snigdha Dravyasa, Ksheera and Shalidhanya.
  • It has Snigdha, Guru, Sthira, Sheeta, Tridoshaghna and Bhrummhana
  • Warmth supplied by Pottali of Shashtika Shali dipped in Balamoola Kwatha with Godugdha may enhanced the blood circulation, decreased muscular stiffness, increased tendon extensibility, and gave relief from pain.[13]

Anuvasana Basti (~Medicated oil Enema):

  • Vata is seen as the main aggravating factor and Basti Chikitsa is regarded as the prime line of treatment for it. Medicated enema helps to eliminate vitiated Dosha from the body, spreads the potency of the drug due to its Prabhava (~specific action) and increases the strength. The potency of Basti drug acting on Dosha brings them into normalcy and provides them with nourishment. Just as the farm gets its nourishment from water supplied through channels, the whole body gets nourishment from Virya (~potency) of the enema drug carried by five types of Vata through Srotas (~bodily channels).[14]
  • Initial 4 Days, Anuvasana Basti was given with Bhrihat Saindhavadi Taila which has Deepana, Pachana, Vedanasthapana, Shothahara and Vata-Kaphahara properties.[15]
  • For the next 5 days Anuvasana Basti was given with Sahacharadi Taila, in which most of the drugs possess Katu Vipaka, Ushna Virya and Laghu, Ruksha Guna and does Kaphavata Samana.[16] This Taila also possess Bhrumhana, Rasayana and Medhya[17] Chemical constituents like Triterpenoids, Phytosterols and Flavonoids present in the Taila has neuroprotective property.[18]

Shamana Aushadhi

Tab. Dhanvantara Vati: The major ingredients are Ela, Shunti, Haritaki, Jiraka helps in Deepana (~appetizer), Vatanulomana (~normalize the movement of Vata).[19]

Rasaushadi Yoga: Ekangaveera Rasa, Mahavata Vidvamsana Rasa, Vatakulantaka Rasa, Vata Ganajankusha Rasa, Bala, Shuddha Shilajitu - Each 160mg


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  • Ekanga Veera Rasa explained in Rasayoga Sagara possesses Deepana, Pachana(~digestive), Teekshana, Bhrumhana(~nourishing) and Rasayana(~rejuvinative) property.[20]
  • Vata Vidvamsana Rasa explained in Rasa Tantra Sara possesses Vatahara, Balya(~strengthening) and Rasayana[21]
  • Vatakulantaka Rasa explained in Bhaishajya Ratnavali Possesses Deepana, Vatahara, Brimhana and Rasayana[22]
  • Vata Gajankusha Rasa explained in Bhaishajya Ratnavali Possesses Deepana, Vatanulomaka, Balya, Rasayana and Vata Pradhana Tridosha Shamaka. [23]

Tab. Anulomana: It is a combination of Swarnapatri (Senna), Ajamoda, Jiraka, Haritaki, Yastimadhu, Shunti and Saindhava Lavana helps in Anulomana Karma.[24]

Conclusion

This case study demonstrates the successful management of Cervical Myelopathy by Ayurveda principles. The significant improvement was assessed by Medical Research Council (MRC) Scale for Muscle Strength, Modified Japanese Orthopaedic Association (mJOA) Score and Myelopathy Disability Index. Significant recovery and improvement were seen in muscle power, walking without support, speech, difficulty in getting up from lying position, grasping and gripping objects, heaviness, pain, fine touch and in the quality of life within 42 Days. So, this case was believed to be value documenting.

References

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2. Wu JC, Ko CC, Yen YS, Huang WC, Chen YC, Liu L, et al. Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study. Neurosurg Focus. 2013 Jul;35(1):E10.

3. Eli MB, Wiliam FY. Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery. 2007;60(1):1-35.

4. Jamson JL, Kasper DL, Longo DL, Fauci AS, Houser SL, Loscalzo J. Harrison’s principles of internal medicine, Diseases of spinal cord. 21st ed. New York: McGraw-Hill Medical Publishing Division; 2022. p. 3452. Chapter 442.

5. Acharya YT. Charaka Samhita with Ayurveda Dipika commentary of Chakrapani Datta. Sutra Sthana 20/11. Reprint ed. Varanasi (India): Chaukambha Orientalia; 2014. p. 113.

6. Singh SK, Rajoria K. Ayurvedic management in cervical spondylotic myelopathy. J Ayurveda Integr Med. 2017;8:49-53.

7. Fehlings MG, Skaf G. A review of the pathophysiology of cervical spondylotic myelopathy with insights for potential novel mechanisms drawn from traumatic spinal cord injury. Spine. 1998;23:2730-7.

8. Gangasahay P, editor. Pt. Kashinath Sastri Vidhyotini Hindi commentator of Caraka Samhita of Agnivesa. 2nd vol., Chikitsa Sthan Vatavyadhi chikitsa Adhayay chapter 28 verse 59e61. Varanasi: Chaukumba Sanskrit Sansthan; 2006. p. 788.

9. Gangasahay P, editor. Pt. Kashinath Sastri Vidhyotini Hindi commentator of Caraka Samhita of Agnivesa. 2nd vol., Chikitsa Sthan Vatavyadhi chikitsa Adhayay chapter 28 verse 239e242. Varanasi: Chaukumba Sanskrit Sansthan; 2006. p. 817.

10. Vagbhatta AV, Tripathi RD, editor. Astanga Samgraha. Sutrasthana, chap. 3:63. Varanasi: Chaukhamba Sanskrit Pratishthana; 2003. p. 50.

11. Charaka Samhita. Edited by Trikamji YA. Varanasi: Chaukhambha Krishnadas Academy; Sutra Sthana; 14:44. p. 90.

12. Nishteswar K, Vaidyanath R. Sahasrayogam; Sanskrit text with English translation, Taila Prakarana chapter 09, verse 3. Reprint ed. Varanasi: Chaukambha Sanskrit series office; 2020. p. 110.

13. Jyani R, Mohar M, Verma K, Dixit R. Effect of Shashtika Shali Pinda Sweda & other Ayurvedic Intervention in Cerebral palsy: A case report. 2023;10(3):51-53.


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14. Sharma S, editor. Sidha Basti kalpa Adhyaya, chapter 5, verse 24. In: Kalpasthana. Ashtanga Samgraha of Vriddha Vagbhatta. 4th ed. Varanasi: Chaukhamba Sanskrit Series Office; 2016. p. 605.

15. Sen GD. Bhaisajya Ratnawali with Hindi commentary by Siddhi Nandan Mishra. Amavata Chikitsa Adhyaya-29. Varanasi: Chaukhambha Subharti Prakashan; 1987. p. 612.

16. Srikantha Murthy KR, editor. Astanga Hridaya; English commentary. Varanasi: Krishnadas Academy; 1991.

17. Nadkarni AK, Nadkarni KM. Indian Materia Medica. Mumbai: Popular Prakashan.

18. Hasnat H, Shompa SA, Islam MM, Alam S, Richi FT, Emon NU, et al. Flavonoids: A treasure house of prospective pharmacological potentials. Heliyon. 2024 Mar 9;10(6):e27533.

19. Nishteswar K, Vaidyanath R. Sahasrayogam; Sanskrit text with English translation, Gutika Prakarana chapter 9, verse 54. Reprint ed. Varanasi: Chaukambha Sanskrit series office; 2020. p. 346.

20. Hariprannaji VP. Rasayogasagara; vol-1, verse 1813-5. Varanasi: Chaukambha Krishnadas Academy; p. 192.

21. Rasa Tantra Sara-Sidha Yoga Sangraha kharaliya Rasayana 37.

22. Das G, Mishra B, Shastri AD. Apasmara Rogadhikara verse 40-43. In: Shastri RD, editor. Bhaishajya Ratnavali Vidhyotini Hindi Vyakhya-Vimarsha-Parishista Sahita. Reprint, 131-2 ed. Varanasi: Chaukhambha Sanskrit Prakashan; 2005. p.

23. Das G, Mishra B, Shastri AD. Raktapitta Rogadhikara verse 102-6. In: Shastri RD, editor. Bhaishajya Ratnavali Vidhyotini Hindi Vyakhya-Vimarsha-Parishista Sahita. Reprint, 131-2 ed. Varanasi: Chaukhambha Sanskrit Prakashan; 2005. p. 701.

24. Varuni BG. An open-labeled clinical study to evaluate the safety and efficacy of Anuloma DS in improving constipation. Indian J Clin Pract. 2023 Jul;34(2).

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