Efficacy of acupuncture for lumbar disc herniation: changes in paravertebral muscle and fat infiltration – a multicenter retrospective cohort study

Lumbar disc herniation (LDH) is one of the leading causes of low back pain and represents a significant public health problem, affecting millions of people worldwide. It is estimated that approximately 80% of adults will experience at least one episode of low back pain during their lifetime, with disc herniation being one of the most frequently diagnosed conditions. With changes in modern lifestyle, including long periods of sitting and sedentary behavior, the prevalence of this condition has been increasing, especially among younger populations. The socioeconomic impact is considerable, including direct medical costs and productivity losses related to functional impairment.

Recently, researchers have recognized that LDH symptoms do not depend exclusively on spinal canal compression but are also closely related to the state of the paravertebral musculature. The paravertebral muscles, including the multifidus, erector spinae, and psoas major, play a fundamental role in maintaining spinal stability. Changes in the quantity and quality of these muscles, such as atrophy and fat infiltration, can compromise lumbar stability and contribute significantly to painful symptoms. Magnetic resonance imaging has proven to be a valuable tool for assessing these muscle changes, allowing precise measurements of muscle cross-sectional area and the degree of fat infiltration.

This multicenter retrospective study was conducted to investigate the efficacy of acupuncture in the treatment of LDH, with a specific focus on structural changes in the paravertebral muscles. The research involved 332 adult patients with LDH, divided into two groups: 166 patients received acupuncture treatment and 166 underwent conventional rehabilitation therapy. The acupuncture group received treatment at specific points such as Shen Shu, Yao Yang Guan, Da Chang Shu, and other relevant points, with daily 20-minute sessions over 20 consecutive days. The rehabilitation group participated in specific exercises, including planks, low-frequency electronic pulse therapy, and muscle stretching.

Using magnetic resonance imaging, the researchers measured the cross-sectional areas of the paravertebral muscles and their respective ratios relative to vertebral area, and quantified fat infiltration. Pain and function were assessed using the Visual Analog Scale (VAS) and the Japanese Orthopaedic Association (JOA) score before treatment, two weeks after, and three months after the intervention.

The results revealed significant benefits of acupuncture treatment compared with conventional rehabilitation. After treatment, the acupuncture group showed significant increases in the cross-sectional areas of the multifidus, erector spinae, and psoas major muscles, as well as in their proportions relative to vertebral area. At the same time, a significant reduction in fat infiltration was observed in these muscles. Regarding pain and function, both treatments produced substantial improvements within the first two weeks, with no statistically significant differences between groups in this initial period.

However, at the three-month follow-up, the acupuncture group demonstrated clear superiority, with significantly lower low back and leg pain scores and higher functional scores than the rehabilitation group. Specifically, acupuncture proved more effective in promoting increases in paravertebral muscle mass and reducing fat infiltration, resulting in more durable pain relief and more pronounced functional improvement.

Clinically, these findings have important implications for both patients and healthcare professionals. For patients with LDH, acupuncture is presented as an effective non-surgical therapeutic option, especially valuable for those seeking to avoid medications or more invasive interventions. The results suggest that acupuncture not only alleviates symptoms but also promotes beneficial structural changes in the paravertebral musculature, potentially contributing to the prevention of recurrence and disease progression. For healthcare professionals, the study offers robust evidence about the mechanisms by which acupuncture exerts its therapeutic effects, going beyond simple pain relief to include improvements in muscle structure.

This can inform clinical decisions about when and how to incorporate acupuncture into treatment plans, especially given its superior long-term effects compared with conventional rehabilitation therapies.

The study has several important limitations that should be considered when interpreting the results. The relatively small sample size and retrospective design may limit the generalizability of the findings. The three-month follow-up period, while sufficient to demonstrate significant benefits, is relatively short for assessing long-term effects and potential recurrence prevention. Additionally, the study population was concentrated in Chinese hospitals, which may limit the applicability of the results to other populations and clinical settings.

Future research should include prospective randomized controlled studies with longer follow-up periods, larger and more diverse samples, and investigation of the molecular mechanisms by which acupuncture influences paravertebral muscle structure and function. Despite these limitations, this study represents a valuable contribution to the scientific literature, providing consistent preliminary evidence regarding the efficacy of acupuncture in treating LDH and offering a new perspective on how this ancient therapy may benefit patients through measurable structural changes in the paravertebral musculature.