Hirudotherapy: indications and contraindications for treatment with leeches

The cervical spine is the most mobile part of the spine. In addition, the neck is a complex anatomical area where blood vessels, trachea, and esophagus pass. Therefore, disc protrusion in the cervical spine is often the cause of both neurological symptoms and vascular disorders associated with effects on the vertebral arteries. As a rule, disc protrusion is associated with degenerative-dystrophic changes in the spine (osteochondrosis). Degenerative processes in the spine tend to progress. Therefore, timely and adequate treatment of protrusion of the cervical spine allows not only to relieve symptoms, but also to prevent the transformation of the protrusion into a disc herniation and avoid the need for surgical treatment.

But there may be other reasons for the development of disc protrusion. Disc inflammation, damage, or degeneration can cause a range of symptoms that vary depending on the severity of the condition. A bulging disc can lead to neck pain that radiates to the arm, numbness, tingling, motor disturbances, muscle spasms, or some combination of these symptoms. The most common degenerative changes and disc protrusion occur at the C5-C6 and C6-C7 levels. Medical statistics indicate that disc protrusion in the cervical spine occurs in 60% of people over 40 years of age. It is worth noting the fact that representatives of the stronger sex get sick more often.

Causes

• Degeneration or wear that leads to disc failure.
• Repetitive flexion (extension) and twisting movements, especially in combination. These movements have the greatest impact on the outer annulus fibrosus of the disc.
• Discs are most susceptible to injury in a sitting or bending position because pressure on the disc is shifted anteriorly and the vector of force forces the contents of the disc posterolaterally toward the thinner, weaker portion of the annulus fibrosus.
• Fall or injury such as a car accident.
• Repetitive stress injuries from overhead work or weightlifting.
• Genetic factors may, to a certain extent, contribute to the early development of degenerative changes in the discs (osteochondrosis).
• Smokers are more likely to develop early disc degeneration
• Infection (discitis)

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Symptoms

Disc bulges in the cervical spine are quite common, and most are not symptomatic. Symptoms of disc protrusion depend on the location of the bulge and the soft tissue structures that are affected. The process may involve: the back of the head, neck, arms, shoulder girdle and hands. Symptoms can range from minor discomfort to severe and persistent.

Most often, the following symptoms occur:

• Pain in the neck, head, shoulder and arm, worsens with minimal strain on the arm, coughing, sneezing;
• Crunching and pain in the neck when turning or tilting the head;
• Muscle spasm and postural changes;
• Numbness, tingling in the arms or legs, burning between the shoulder blades;
• Headache, which usually begins in the neck and spreads to the back of the head and temples;
• Dizziness and even fainting when suddenly turning the head;
• Decreased range of motion in the neck, difficulty moving the head and neck;
• Sitting for long periods of time can cause neck and arm pain;
• Pain in the neck or radicular pain radiating to the arm if the disc compresses a nerve root.
• Weakness, muscle atrophy, or decreased strength in the arms may occur if motor neuron compression occurs.
• Feeling weak and tired;

Other symptoms of cervical disc protrusion include tinnitus, decreased visual acuity and hearing, and sometimes pain in the heart area.

Is it possible to cure osteochondrosis with leeches?

Hirudotherapy for osteochondrosis can completely or partially restore the condition of the spine, eliminate pain and other unpleasant symptoms.

In the initial stages of the disease, complete restoration of spinal function is possible. In the later stages, when compensatory growth of bone tissue occurs or complications develop in the form of intervertebral hernias, treatment with leeches for osteochondrosis significantly alleviates the patient’s condition, eliminates pain, inflammation, improves blood circulation in the affected area, and restores performance.

Red flags for neck pain

A serious underlying cause is more likely in people who:

• The onset of symptoms appeared before the age of 20 years or after 55 years.
• Weakness involving more than one myotome or sensory disturbance involving more than one dermatome.
• Intense or increasing pain.

Red flags suggesting possible malignancy, infection or inflammation:

• Fever.
• Unexplained weight loss.
• History of inflammatory arthritis.
• A history of malignancy, drug abuse, tuberculosis, AIDS, or other infection.
• Immunosuppression.
• Pain that gets worse, is very intense and/or disturbs sleep.
• Lymphadenopathy.
• Local point tenderness over the vertebral body.

Red flags suggesting myelopathy (spinal cord compression):

• Progression of symptoms.
• Gait disturbance; weakness or impaired motor function in the hands; loss of bladder/bowel control.
• Lhermitte's sign (bending the neck causes an electric shock sensation that travels down the spine and into the extremities).
• Pathological symptoms in the lower extremities (Babinski reflex, hyperreflexia, clonus, spasticity) and in the upper extremities (atrophy, hyporeflexia).
• Various sensory changes (loss of proprioception more noticeable in the arms than in the legs).

Red flags indicating the possibility of severe skeletal injury:

• Trauma history.
• Previous neck surgery.
• Osteoporosis or risk factors for osteoporosis.
• Increase and persistence of pain.

Red flags indicating vascular insufficiency:

• Dizziness and darkening before the eyes (compression of the vertebral artery) when moving, especially when straightening the neck.
• Dizziness, syncope episodes.

Result

A leech is a living syringe with a unique set of biologically active substances, the action of which causes various effects in the human body: lowering blood pressure, improving blood clotting; For many women, leeches helped get rid of fibroids and mastopathy, dysfunctional and inflammatory gynecological disorders.

Cosmetologists appreciated hirudotherapy. The unique chemical composition of leech saliva ensures instant interaction of its components with skin cells. As a result, the skin is renewed, becomes elastic, firm, and beautiful. It takes on a pink tint, becomes soft and smooth.

Differential diagnosis of neck pain

As a rule, most back pain is associated directly with changes in the discs (protrusion, disc herniation), however, for an accurate diagnosis it is necessary to use medical imaging methods.

Differential diagnoses include:

• Cervical spondylosis.
• Traumatic prolapse of an intervertebral disc.
• Neck pain: acute neck strain, postural neck pain, or pain associated with whiplash injury
• Headache.
• Referred pain - for example, from the shoulder.
• Malignancies: primary tumors, metastases or myeloma.
• Infections: discitis, osteomyelitis or tuberculosis.
• Fibromyalgia.
• Vascular insufficiency.
• Psychogenic neck pain.
• Inflammatory diseases (for example, rheumatoid arthritis).
• Metabolic diseases: Paget's disease, osteoporosis.

Characteristic

Depending on the location of the pathology, a paraovial cyst can be:

• right-sided;
• left-handed.

Tumors are classified according to size:

1. Small - up to 2.5 cm without stem. They occur without characteristic signs and do not cause any complications.
2. Large - more than 5 cm. They can form a pedicle, which consists of an ovary or fallopian tube. The presence of a stalk can lead to serious complications, as it can twist, causing inflammation and suppuration of the contents of the capsule.

Diagnosis of disc protrusion

Neck pain from radiculopathy and the absence of red flag symptoms usually do not require imaging or other special tests. However, for verification purposes, the doctor may prescribe the following research methods:

Blood tests

may be prescribed to exclude infectious or inflammatory diseases (a decrease in hemoglobin may be a sign of anemia; an increase in ROE may be a sign of both infection and inflammation; the level of rheumatoid factor and HLA-B27 determination may indicate systemic connective tissue diseases).

Medical imaging tests are very important, but they must be interpreted in light of the clinical picture, since positive results are quite common in people without any complaints:

• Radiography

. Plain x-rays of the cervical spine can be used to evaluate chronic degenerative changes, metastatic tumors, infection, spinal deformity, and motion segment stability. Interpretation of study results is often difficult because degenerative signs are almost universal in people over 35 years of age.

• MRI.

This imaging method may be prescribed if radiography does not allow the genesis of symptoms to be determined. MRI should be performed to diagnose disc protrusion (herniation) and the presence of compression of nerve structures.

• CT myelography

can be used if there are any contraindications to MRI.

•EMG (ENMG

) - these methods can be informative in the presence of radiculopathy or the need to determine the level of damage and differentiate cervical radiculopathy from nervous compression syndromes.

Contraindications and precautions

Despite the effectiveness of leeches, they cannot be recommended for all patients. Hirudotherapy is contraindicated for pregnant women and women breastfeeding. An indirect contraindication will be tumors of any nature, including benign ones. Procedures with leeches should not be carried out if:

• decreased blood clotting (hemophilia);
• autoimmune diseases;
• diabetes mellitus type 1 in the acute stage;
• tuberculosis;
• severe anemia;
• weight deficiency;
• allergies to hirudin and other active substances.

Contraindications will be increased skin sensitivity, the presence of any fungal, viral or infectious diseases. High temperature and general deterioration in health are reasons for urgent interruption of the course. It will be possible to resume it only after the therapist confirms that the patient is completely healthy.

Treatment

As a rule, treatment of protrusion of the cervical spine uses conservative methods, and surgical treatment is rarely required. Conservative treatment relieves symptoms and stops the progression of the disease.

The doctor prescribes a course of treatment for the patient, taking into account the clinical picture, age, gender and characteristics of the body. Treatment of protrusion of the cervical spine can take up to one and a half months. The patient undergoes procedures 2-3 times a week. Neck pain can usually be relieved after 1-2 weeks of treatment. The following methods can be used in the course of treatment:

Sources

1. Abduvaliev A.A. Hirudotherapy in the complex treatment of patients with reactive arthritis / A.A. Abduvaliev, A.M. Daurekhanov // Bulletin of KazNMU. - 2021. - No. 1. - P. 249-252.
2. Konyrtaeva N.N. Hirudotherapy for diseases of the circulatory system / N.N. Konyrtaeva [and others] // Human Ecology. - 2015. - No. 6. - P. 57-64.
3. Kuznetsova L.P. The place of hirudotherapy in the complex treatment of chronic heart failure / L.P. Kuznetsova [and others] // Russian Journal of Cardiology. - 2008. - No. 2 (70). — P. 28-30.
4. Taraba T.S. Hirudotherapy (part 1): definition, indications, contraindications / T.S. Taraba // Bulletin of the Clinical Hospital No. 51. -2016. — P. 9-13.

Surgery

The most common disc-related surgery is a discectomy, in which the disc is removed through an incision. In the cervical spine, discectomy can be performed either anteriorly or posteriorly. In some cases, vertebral fusion surgery may be recommended. Most patients who have a discectomy recover fairly quickly from surgery with the help of physical therapy. Discectomy is usually performed when a herniated disc is present, as most disc bulges can be successfully treated conservatively.

Hirudotherapy: features of the technique

Bleeding using leeches is one of the most ancient medical procedures.
The first mentions of it are found in ancient chronicles, but the peak of popularity occurred in the Middle Ages. Doctors actively used bloodletting for a variety of ailments, from complications during childbirth to migraines. In some cases, up to 40 leeches were attached to the patient’s body at the same time. It was believed that worms were able to suck out “bad blood,” which would help avoid apoplexy, cure various pathologies of internal organs, and even save them from poisoning or gangrene. Today, hirudotherapy is outside the brackets of official medicine. However, doctors admit that in some cases, leeches can alleviate the patient's condition. You should not rely only on this technique; bloodletting demonstrates the best effect in combination with other medical procedures: massages, manual therapy, taking medications.

Treatment with leeches is carried out in specialized hirudotherapy centers.

The procedures require medicinal leeches, a type of annelid worm that feeds on blood. In the wild, they live in freshwater bodies, but only individuals grown in special biofactories under sterile conditions are used for medicinal purposes.

Modern hirudotherapy involves several options for using leeches:

1. Live. The worms attach themselves to the skin, biting through it and at the same time injecting an anesthetic substance. The patient does not feel any discomfort; after saturation, the bloodsucker falls off on its own. A wound remains at the site of the bite, which heals after a couple of days.
2. In the form of sublimates. Medicinal extracts are made from the leeches themselves or their salivary glands. The remedies can be used in courses; they are suitable for people who do not tolerate traditional hirudotherapy well.
3. In the form of recombinant drugs. Medicines of artificial origin are made based on the gene of medicinal leeches introduced into the DNA of microorganisms. The drugs are well absorbed and cause minimal side effects.

During a session, one leech drinks up to 15 ml of blood. After use, the worms are destroyed and reuse is prohibited.

When treating with live leeches, the main therapeutic effect is associated with the forced outflow of blood. Reducing the filling of blood vessels can reduce blood pressure and improve the patient's condition. An additional effect is provided by the placement of leeches in accordance with the rules of acupuncture. Micro-punctures create an acupuncture effect and affect the condition of certain organs. It is worth considering the medicinal properties of leech saliva. It consists of the following components:

1. Hirudin. An anticoagulant protein, an analogue is found in the venom of some reptiles. Reduces blood clotting, prevents thrombosis, improves vascular patency.
2. Collagenase and asperase. Enzymes that inhibit platelet aggregation.
3. Protein inhibitors. Substances that block protoinases and prevent the destruction of protein molecules.
4. Vasodilators. Compounds that improve blood flow by dilating blood vessels.
5. Anesthetic components. They have an analgesic effect, thanks to which the patient does not feel discomfort during and after the procedure.

For treatment, you can use synthetic drugs created based on the leech gene.