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

Table 1 Summary of findings for Grading of Recommendations Assessment, Development and Evaluation ratings

Outcome measure	Quality of evidence assessment (GRADE)
	No of patients (effect size)	Risk of quality of bias1	Inconsistency2	Evidence6	Indirectness3	Imprecision4	Publication5
Effective rate	1184	Serious	Very low	Low	Not serious	Very low	Very low
VAS	1184	Low	Very serious	Low	Not serious	Very low	Very low
NDI	734	Low	Very serious	Low	Not serious	Very low	Very low
YT20	246	Serious	Very serious	Low	Not serious	Not serious	Very low

¹Risk of bias based on the Cochrane risk of bias tool. This tool assesses selection bias, performance bias, detection bias, attrition bias, and reporting bias.

²Downgraded if there was a substantial unexplained heterogeneity. Downgraded one level for serious inconsistency: 50% < I² ≤ 75%; downgraded two level for very serious inconsistency: 75% < I² < 100%.

³Downgraded if there were factors present relating to the participants, interventions, or outcomes that limited the generalizability of the results.

⁴Downgraded if the number of participants are very small (n < 200).

⁵Downgraded if there was an evidence of publication bias using Egger’s test.

⁶Given that all included studies were meta-analyses of randomized controlled trials, the evidence certainty was initially rated as high for all outcomes and sub- sequently downgraded according to predefined criteria. Quality was graded as high, moderate, low, and very low.

GRADE: Grading of Recommendations Assessment, Development and Evaluation; VAS: Visual Analog Scale; NDI: Neck Disability Index; YT20: Yasushi Tanaka cervical spondylitis symptom scale 20 scores.

Table 2 Basic characteristics of the include literature

Ref.	Nation	Sample size	Duration of treatment	Interventions	Therapeutic process	Outcome indicator	Safety evaluation
Deng[10], 2017	China	E: 30 C: 30	E: 3 weeks C: 3 weeks	E: N + C C: C	E: Once every 2 days	Effective rate	N
					C: Once a day	VAS
Yang[11], 2019	China	E: 30 C: 30	E: 3 weeks C: 3 weeks	E: N + C C: C	E: Once every 2 days	Effective rate	Y
					C: Once a day	VAS, NDI, YT20
Xu[12], 2018	China	E: 33 C: 33	E: 4 weeks C: 4 weeks	E: N C: C	E: Once every day	Effective rate	N
					C: Once every day	VAS, YT20
Wang and Huo[13], 2019	China	E: 43 C: 43	E: 2 weeks C: 2 weeks	E: N C: C	E: Once every day	Effective rate	N
					C: Once every day	VAS, NDI, YT20
Li et al[14], 2022	China	E: 30 C: 30	E: 6 weeks C: 6 weeks	E: N C: C	E: Once every day	Effective rate	N
					C: Once very day	VAS
Wu et al[15], 2022	China	E: 18 C: 18	E: 2 weeks C: 2 weeks	E: N + C C: C	E: Once every 3 days	Effective rate	Y
					C: Once every day	VAS, NDI
Ma[16], 2019	China	E: 102 C: 102	E: 2 weeks C: 2 weeks	E: N C: C	E: Once every 2 days	Effective rate, VAS	N
					C: Once every day
Hu[17], 2019	China	E: 30 C: 30	E: 4 weeks C: 4 weeks	E: N C: C	E: Once every day	Effective rate, VAS,	Y
					C: Once every day
Zhou et al[18], 2022	China	E: 50 C: 50	E: 4 weeks C: 4 weeks	E: N + C C: C	E: Once a week	Effective rate	Y
					C: Once every day	VAS, NDI
Yin et al[19], 2024	China	E: 50 C: 50	E: 2 weeks C: 2 weeks	T: N C: C	E: Once ten days	Effective rate	N
					C: Once every day	VAS, NDI
Li et al[20], 2023	China	E: 53 C: 53	E: 3 weeks C: 3 weeks	E: N + C C: C	E: Once every day	Effective rate	N
					C: Once every day	VAS, NDI
Liu et al[21], 2024	China	E: 30 C: 30	E: 2 weeks C: 2 weeks	E: N C: C	E: Once every day	Effective rate	N
					C: Once every day	VAS, NDI, YT20
Zhang and Yao[22], 2020	China	E: 30 C: 30	E: 3 weeks C: 3 weeks	E: N C: C	E: Once every day	Effective rate	N
					C: Once every day	VAS
Jin[23], 2021	China	E: 33 C: 33	E: 4 weeks C: 4 weeks	E: N C: C	E: Once every day	Effective rate, VAS, NDI	N
					C: Once every day	Effective rate, VAS, YT20
Li and Wang[24], 2021	China	E: 30 C: 30	E: 3 weeks C: 3 weeks	E: N C: C	E: Once every day		N
					C: Once every day

E: Experiment group; T: Control group; N: Needle knife; C: Conventional therapy; VAS: Visual Analog Scale; NDI: Neck Disability Index; YT20: Yasushi Tanaka cervical spondylitis symptom scale 20 scores.