The efficacy of acupuncture therapies in cervical spondylotic radiculopathy: A network meta-analysis

Neck pain due to cervical spondylotic radiculopathy is a health problem that affects about 0.35% of the world population, accounting for up to 70% of all cervical spine diseases. This condition arises when the nerve roots of the neck are compressed due to problems such as disc herniation, ligament laxity, or abnormal bone growth, resulting in neck and shoulder pain, in addition to numbness in other areas. With the modern lifestyle and increasing everyday pressures, this condition has become increasingly frequent, especially among older people.

Treatment of cervical spondylotic radiculopathy can be performed through surgery or conservative methods. Although surgery can be effective in severe cases, it carries significant risks, with serious complications occurring in up to 8% of cases, including injuries to the esophagus, neck blood vessels, nerves, or even death. In addition, the financial cost is considerable, and the postoperative recurrence rate can reach 30%. On the other hand, conservative treatments with medication can cause gastrointestinal, hepatic, and renal problems.

In this context, acupuncture emerges as a promising therapeutic alternative, as it is believed to relieve pain through the stimulation of specific points and activation of the nervous-endocrine-immune system.

This study aimed to determine which type of acupuncture is most effective in treating this condition, using a methodology called network meta-analysis. The researchers conducted a systematic search of Chinese and English databases from inception through November 2023, looking for randomized controlled clinical trials comparing different types of acupuncture. To be included, studies needed to have adequate methodological quality, patients between 18 and 65 years of age with confirmed diagnosis of the condition, and use standardized scales to measure pain, neck disability, and overall clinical performance.

The final analysis included 28 studies involving 2,593 patients, comparing 14 different acupuncture interventions. The treatments analyzed included conventional acupuncture, electroacupuncture, acupotomy, fire needle, Fu's subcutaneous needling, Qihuang needle, acupoint catgut implantation, warm needle, and long round needle, in addition to other treatments such as physical therapy, Chinese medicine, Western medicine, and massage. Outcomes were assessed via three scales: the Visual Analog Scale for pain, the Neck Disability Index for functionality, and the 20-point Tanaka-Yasuhiro scale for overall clinical performance.

The main results revealed important differences between treatments. For pain relief, acupoint catgut implantation proved superior, followed by Fu's subcutaneous needling and acupotomy. These three methods demonstrated significantly greater efficacy than conventional acupuncture, electroacupuncture, Western medications, and physical therapy. To improve neck functionality, acupotomy was the most effective treatment, surpassing even other acupuncture methods such as warm needle and fire needle.

When considering overall clinical performance, again acupotomy and Qihuang needle showed the best results.

The clinical implications of these findings are important for both patients and healthcare professionals. For patients, the results offer valuable information on which types of acupuncture may provide greater symptom relief. Acupoint catgut implantation, for example, combines traditional acupuncture with modern physical effects, providing prolonged stimulation of the points after a single treatment, similar to the "retained needle" effect of traditional acupuncture. Fu's subcutaneous needling focuses on the subcutaneous tissue around specific points, improving the hypoxic state of the affected muscles.

Acupotomy, in turn, combines properties of acupuncture and surgical scalpel, helping to reduce muscle spasms and improve local circulation.

For healthcare professionals, these results provide scientific evidence to guide the choice of the most appropriate treatment. It is important to consider that different types of needles provide stimuli of varying intensities — thicker needles such as those used in acupotomy and Fu's needling offer stronger stimulation due to a greater mechanical effect. Treatments such as warm needle and fire needle add a thermal effect to traditional acupuncture, potentiating the acupuncture sensation. Practitioners should also consider Chinese medicine principles in syndrome differentiation and specific clinical characteristics of each patient when selecting treatment.

The study has some important limitations that should be considered. The methodological quality of the included studies was only moderate, with several studies not adequately reporting their randomization or allocation concealment methods. The diversity of acupuncture treatments and the variation in treatment periods may have introduced biases into the results. Furthermore, most studies were conducted in China and published in Chinese, which may have created a language bias.

The small number of studies for each specific intervention also limited the ability to perform more detailed analyses.

In conclusion, this network meta-analysis provides evidence that certain acupuncture techniques may be more effective than others in the treatment of cervical spondylotic radiculopathy. Acupoint catgut implantation showed the best results for pain relief, while acupotomy was superior for improving cervical functionality and overall clinical performance. Although these results are promising, more high-quality studies with larger samples are needed to confirm these conclusions. Patients interested in acupuncture for this condition should seek qualified professionals who can assess their individual characteristics and select the most appropriate type of treatment.