Needle knife therapy for cervical spondylotic radiculopathy: A systematic review and meta-analysis

Abstract

BACKGROUND

Cervical spondylotic radiculopathy (CSR), a prevalent form of cervical spondylopathy, significantly impacts patients’ quality of life. Current management primarily relies on conservative approaches. In recent years, needle knife therapy, as a new type of therapy, has been used in the treatment of CSR.

AIM

To evaluate the therapeutic efficacy of needle-knife therapy for CSR and compare its advantages over conventional treatments, including acupuncture, massage, and warm acupuncture.

METHODS

Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, PubMed, VIP Chinese Science and Technology Journal Database, China Biology Medicine, and other databases were searched for randomized controlled trials (RCTs) of needle-knife therapy for CSR from the establishment of the database to November 3, 2025. Two independent researchers performed literature screening based on predefined inclusion and exclusion criteria, followed by secondary screening and quality assessment. The Cochrane risk of bias tool was utilized for assessing the methodological quality of the included RCTs. Data synthesis and analysis were performed using RevMan 5.4 software, focusing on treatment effective rates, Visual Analog Scale (VAS) scores, Neck Disability Index (NDI) scores, and Yasushi Tanaka cervical spondylitis symptom scale 20 (YT20) scores.

RESULTS

A total of 15 RCTs, encompassing 1184 patients (592 in the experiment group and 592 in the control group), were included in this meta-analysis. Potential high risks of bias in randomization, allocation concealment, and blinding procedures may adversely affect the overall methodological quality of the included trials. The results of meta-analysis showed that the effective rate of the experiment group was significantly higher than that of the control group [mean differences (MD) = 0.10, 95% confidence interval (CI): 0.07-0.14, Z = 6.03, P ≤ 0.00001]; the safety and YT20 scores [safety: MD = 0.34, 95%CI: 0.14-0.83, Z = 2.36, P = 0.02, YT20 scores: standardized MD (SMD) = 2.05, 95%CI: 1.24-2.86, Z = 4.94, P ≤ 0.00001] in the experiment group were higher than those in the control group. The VAS score (SMD = -0.93, 95%CI: -1.59 to -0.27, P ≤ 0.0001), NDI score (SMD = -4.04, 95%CI: -5.01 to -3.07, P ≤ 0.0001) in the experiment group were lower than those in the control group. Significant heterogeneity was observed for VAS (I² = 99%) and NDI (I² = 84%) scores. Sensitivity analysis did not find significant reversal, indicating that the results of the included studies were reliable.

CONCLUSION

Needle-knife therapy for CSR presents a higher efficacy and improved clinical outcome scores when contrasted with conventional treatments. However, these findings are constrained by the generally low quality of the included trials and notable heterogeneity observed in some studies. Consequently, the results should be interpreted with caution and considered preliminary. Further validation through larger, high-quality RCTs is warranted, given the existing limitations in sample size and methodological rigor.

Keywords: Needle-knife therapy; Cervical spondylotic radiculopathy; Randomized controlled trial; Systematic review; Meta-analysis

Core Tip: This study aims to evaluate the therapeutic efficacy of needle-knife therapy for cervical spondylotic radiculopathy through a meta-analysis of 15 randomized controlled trials encompassing 1184 patients. The research addresses three core issues: comparative effectiveness versus conventional treatments (acupuncture, massage, warm acupuncture), comprehensive clinical outcome assessment (effective rates, Visual Analog Scale scores, Neck Disability Index scores, and Yasushi Tanaka cervical spondylitis symptom scale 20 scores), and methodological quality evaluation using Cochrane risk of bias tool. Results demonstrate superior effective rates and improved symptom scores. Findings provide preliminary support for needle-knife therapy while emphasizing the need for larger, high-quality randomized controlled trials to validate these results.