Needle-knife therapy for lumbar disc herniation: A systematic review and meta-analysis

To explore the effectiveness of needle-knife therapy for lumbar disc herniation and its advantages compared with traditional treatments.

PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, China National Knowledge Infrastructure, ClinicalTrials.gov, and the Chinese Clinical Trial Registry were searched with a cutoff date of March 1, 2025. Randomized controlled trial studies comparing needle-knife therapy or needle-knife combined with traditional therapy with traditional therapy were included. Cochrane risk assessment software was used to assess bias risk in the included randomized controlled trials (RCTs). Meta-analysis was conducted using RevMan 5.4.1 software, and GRADE was used to assess the quality of evidence for each outcome.

A total of 12 RCTs were included, with 1160 patients. Compared with traditional treatment, needle-knife combined with traditional treatment significantly improved the treatment efficacy (mean difference [MD] = 5.19, 95% confidence interval [CI]: 2.91-9.26, P = .0001, I2 = 0%). Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) scores were all improved compared to traditional treatment (VAS: MD = -1.44, 95% CI: -1.60 to -1.28, P = .0001, I² = 93%, JOA: MD = 2.93, 95% CI: 1.88-3.98, P = .0001, I² = 0%, ODI: MD = -4.93, 95% CI: -5.68 to -4.18, P = .0001, I2 = 0%). Compared with traditional treatment, simple needle-knife therapy was superior in terms of efficacy, VAS, JOA, and ODI scores (efficacy: MD = 2.26, 95% CI: 1.27-4.03, P = .006, I2 = 0%, VAS: MD -1.12, 95% CI: -1.23 to -1.01, P = .0001, I2 = 99%, JOA: MD = 3.73, 95% CI: 3.0-4.45, P = .0001, I2 = 0%). Sensitivity analysis showed no significant reversal, indicating the reliability of the included results.

Compared with traditional treatment, needle-knife therapy for lumbar disc herniation is superior in terms of efficacy and scores. However, due to the lack of high-quality literature and limited sample sizes, more large-sample, multi-center, high-quality RCTs should be conducted using scientific methods.