Yet Another Form of 'Acupunctures'

Yet Another Form of 'Acupunctures'

Anything can be called acupuncture and some give me the willies. For example Effects of Wonli Acupuncture Procedure in Patients with LSS: A Clinical, Retrospective Study.

Spinal stenosis is just that: the spinal canal narrows putting pressure on the spinal cord and nerve roots. It is a mechanical problem that can have symptomatic relief with medications but in the end the treatment is surgical. The narrowing has to be opened up by removing bone and thickened ligaments.

Or try Wonli acupuncture, which is a form of

Acupotomy.. an acupuncture procedure developed for synechia, nodules, and cicatrix caused by soft tissue damage, in short, a combination of acupuncture and ectomy.

They are using acupuncture to cut and remove tissues. Just want you want, people with little real training in anatomy, medicine, or surgery cutting and slashing tissues around the spine. The references suggest it has been used to treat carpal tunnel syndrome, a form of cutting the wrist not meant as a suicide gesture. I suppose, since I cannot get the original paper.

Using various needles in succession, they

(1) Insert acupuncture needle 1 through point A perpendicular to the skin toward the lumbar zygapophyseal joint. Keep the blade parallel with the articular surface of facet joint and incise the facet joint capsule using acupuncture needle 1. Incise the solidification in/out/up/down of the articular process along the bone surface and then incise the synechia of multifidus muscles and rotator muscles in parallel with the muscle grain direction to stretch the shortened muscle.

(2) Use acupuncture needle 2 to penetrate through the epidermis at points A and B to secure the inserting point of acupuncture needles 3 and 4. Incise the epidermis layer only to the depth of 10~15 mm.

(3) Holding the handle of acupuncture needle 3 insert it perpendicular to point B to a depth of 10 mm, passing through the epidermis. Then, keeping the angle with the epidermis at 45 degrees, insert the needle vertically to the depth of 8~12 cm toward the intervertebral foramen of the disk level until it reaches the anterior part of superior articular process. After reaching the intervertebral foramen of the spine, exfoliate the synechia of soft tissues in the vicinity of the intervertebral foramen located on the anterior side of the facet joint and inside the pedicle, all along the bone surface (see Figure 6).

(4) Insert acupuncture needle 4 perpendicular to point A until it reaches the facet joint and then slowly insert it along the internal part of the surface of facet joint bone. Incise the adhered and thickened ligamentum flavum in the interlaminar space along the bone surface. Repeat this procedure until resistance of the yellow ligaments is resolved, indicated by loose feeling. When the yellow ligaments are exfoliated sufficiently, move further toward the intervertebral foramen to exfoliate the synechia in the spinal canal (see Figure 7).

As they state in the discussion.

However, acupuncture needle 1, most commonly used in China, has a knife at the needle tip. And despite minimizing the damage during insertion, there are limitations in directly entering the spinal canal and manipulating the needle due to the risk of nerve and blood vessel damage.

You think? Essentially it is like the old frontal lobotomy (not for the squeamish), blinding sticking a spike into tissues and blindly wiggling it around.  At least it was all done under aseptic technique, although not with local anaesthesia.

In this series, some improved, some did not, and some worsened:

When we observed the therapy results, some patients got better right after a single procedure while some improved gradually over several months. In the latter case, they seemed to take time recovering from denaturalization of the damaged nerve and its surrounding tissues. Not only this, but according to clinical observation patients who obtained no effect from the Wonli Acupuncture procedure seemed to have experienced regressive changes of the spine. Judging from this, they may have gotten worse despite their recovery in the first postprocedure period.

And perhaps it was the Wonli that made them worse. And in this an  another series patients had up to three of these procedures done.

In a retrospective non-placebo controlled trial it is ridiculous to suggest

Wonli Acupuncture was found to have clinical efficacy for lumbar spinal stenosis.

Such a trial is at huge risk for bias. And the error bars for the outcomes suggest that the 'significant' results are not.  As is so often the case in acupuncture studies, the conclusion of efficacy is not supported by the data in the paper.

It is a form of surgery using acupuncture needles with nothing to do with the half dozen other 'real', classic acupunctures based on qi and meridians. It doesn't work. And it gives me the heebie-jeebies. 

California Legislature tries to reform Acupuncture...
Points of Interest: 07/22/2014