Rédacteurs : Johan Nguyen, Jean-Luc Gerlier, Olivier Goret, Henri Truong
cervical radiculopathy
Névralgie cervico-brachiale
| ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture. |
| ☆☆ | Evidence for effectiveness of acupuncture. |
| ☆ | Evidence for effectiveness of acupuncture mais limitées qualitativement et/ou quantitativement. |
| Ø | No evidence or insufficient evidence. |
1.1. Generic Acupuncture
1.1.1. Zhao 2024
Zhao H, Wang C, Wang X, Ju J, Yan C, Shi B. Efficacy and Safety of Acupuncture in the Treatment of Radicular Cervical Spondylosis: A Systematic Review and Meta-Analysis. Comb Chem High Throughput Screen. 2024;27(19):2951-2962. https://doi.org/10.2174
| Background | Cervical spondylotic radiculopathy is a serious and common degenerative disease of the cervical spine due to irritation and compression of the nerve roots of the cervical spine, resulting in a series of clinical symptoms based on sensory, motor and reflex disorders, such as numbness and pain in the neck, shoulders, upper limbs and fingers. Acupuncture is highly effective in treating CSR and has become a common treatment accepted by patients. This study aims to systematically review and analyze existing randomized controlled trials (RCTs) to evaluate the efficacy and safety of acupuncture in the treatment of CSR. |
| Methods | We used the following eight databases for literature data search: PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Biology Medicine Disc ( CBMdisc), Wanfang Database and China Science and Technology Journal Database (VIP). The search consisted of randomized controlled studies of acupuncture for CSR between 2000 and 2020 and the methodological quality of the included studies was assessed according to the Cochrane Collaboration's “Risk of Bias Assessment Tool.”RevMan 5.4 software was used for statistical analysis only. Study screening, data extraction and statistics, and assessment of the risk of bias of the included studies were performed independently by two reviewers. |
| Result | 27 studies with 3124 patients were included. The results of the meta-analysis of the total efficiency index for acupuncture for CSR were [RR = 1.14,95% CI (1.09,1.19)]. The results of the meta-analysis of the PPI index were [MD = -0.35, 95% CI (-0.61,-0. 09)]. The results of META analysis of the total effective rate, VAS score, PRI(A) score, PRI(S) score and PRI(T) score showed heterogeneity in the studies included for each outcome index, and sources of heterogeneity were sought through subgroup analysis and sensitivity analysis to ensure more stable and reliable data results. The results of the combined meta-analysis showed that the treatment group was significantly more effective than the control group and more effective in lowering the nerves to reduce the pain index in patients with CSR, with a statistically significant difference (P<0.05). This indicates that acupuncture treatment is superior to traction for CSR. |
| Conclusion | Acupuncture is significantly more effective than traction therapy in the treatment of cervical spondylosis and can reduce the pain index of patients with CSR. |
1.1.2. Plener 2023
Plener J, Csiernik B, To D, da Silva-Oolup S, Hofkirchner C, Cox J, Cancelliere C, Chow N, Hogg-Johnson S, Ammendolia C. Conservative Management of Cervical Radiculopathy: A Systematic Review. Clin J Pain. 2023 Mar 1;39(3):138-146. https://doi.org/10.1097/AJP.0000000000001092
| Objective | The purpose of this systematic review was to assess the effectiveness and safety of conservative interventions compared with other interventions, placebo/sham interventions, or no intervention on disability, pain, function, quality of life, and psychological impact in adults with cervical radiculopathy (CR). |
| Methods | We searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022 to identify studies that were randomized controlled trials, had at least one conservative treatment arm, and diagnosed participants with CR through confirmatory clinical examination and/or diagnostic tests. Studies were appraised using the Cochrane Risk of Bias 2 tool and the quality of the evidence was rated using the Grades of Recommendations, Assessment, Development, and Evaluation approach. |
| Results | Of the 2561 records identified, 59 trials met our inclusion criteria (n = 4108 participants). Due to clinical and statistical heterogeneity, the findings were synthesized narratively. There is very-low certainty evidence supporting the use of acupuncture, prednisolone, cervical manipulation, and low-level laser therapy for pain and disability in the immediate to short-term, and thoracic manipulation and low-level laser therapy for improvements in cervical range of motion in the immediate term. There is low to very-low certainty evidence for multimodal interventions, providing inconclusive evidence for pain, disability, and range of motion. There is inconclusive evidence for pain reduction after conservative management compared with surgery, rated as very-low certainty. |
| Discussion | There is a lack of high-quality evidence, limiting our ability to make any meaningful conclusions. As the number of people with CR is expected to increase, there is an urgent need for future research to help address these gaps. |
1.1.3. Yin 2019
Yin Xunlu, Zhu Liguo, Feng Minshan, Wei Xu, Yu Jie, Liang Long. [Meta-analysis of Acupuncture Efficacy on Nerve Root Cervical Spondylosis Therapy]. Rehabilitation Medicine. 2018;4:63-69. [201745].
| Objective | To systematically review the efficacy and safety of acupuncture in the therapy of cervical spondylotic myelopathy. |
| Methods | Randomized controlled trials(RCT)about acupuncture therapy on nerve root type cervical spondylosis were electronically searched in CNKI, Pub Med, EMBase, Wanfang Data. After conducting quality evaluation according to the “bias risk assessment tool” in the Cochrane Collaboration, the results of Meta-analysis were analyzed by Rev Man 5.3 software. |
| Results | A total of 11 RCTs involved 974 patients were finally included. Meta-analysis indicated that acupuncture combined with traction in the therapy of nerve root type cervical to improve spondylopathy pain relief [MD=-1.69,95% CI(-2.63,-0.75)]; to improve the current pain conditions(PPI)[MD=-0.41, 95% CI(-0.56,-0.26)]; pain relief [VAS(Mc Gill)] [MD=-1.43, 95% CI(-2.21,-0.6)]; total pain score(PRI)[MD=-2.43, 95% CI(-4.06,-0.80)]; pain perception total score [PRI(S)] [MD=-1.63, 95% CI(-2.07,-1.20)]; Pain Emotion Total Score [PRI(A)][ MD=-0.89, 95% CI(-1.39,-0.38)]. The effect of acupuncture group in cervical spondylotic myelopathy therapy was better than that of the traction group, the difference was statistically significant(P<0.05). |
| Conclusion | Acupuncture has good curative effect and advantage in the therapy of cervical spondylosis of nerve root type. However, there are many deficiencies in low-quality inclusion studies and heterogeneity between studies in this systematic review, large-sample, high-quality randomized controlled trials are necessary for validation in the future. |
1.1.4. Hu 2012 (versus traction) ☆
Hu J, Chu HR, Sun K, Xiao W, Song YC, Long XN. [Clinical effect of acupuncture in treatment of cervical spondylotic radiculopathy: a systematic review]. Journal of Anhui Traditional Chinese Medical College. 2012;5:39-43. [186982].
| Objective | To assess and compare the clinical effects and safeties of acupuncture and traction therapy in the treatment of cervical spondylotic radiculopathy (CSR) by a systematic review. |
| Methods | A search was performed in various worldwide databases for a systematic review of randomised controlled trials of acupuncture and traction therapy for treating CSR. Methodological quality assessment was conducted according to Cochrane Handbook for Systematic Reviews of Interventions Version 5. 1. 0, and effect sizes were calculated. Meta-analysis or descriptive analysis was performed. |
| Results | Fourteen studies involving 1 542 cases were included. Acupuncture was safe in the treatment of CSR. Acupuncture showed better clinical effect than traction therapy in the treatment of CSR (RR: 1. 20;95% CI: 1. 13-1. 27 vs RR: 1. 14, 95% CI: 1. 09-1. 20). In addition, acupuncture had better analgetic effect and could reduce recurrence. |
| Conclusion | Acupuncture is probably superior to traction therapy in the treatment of CSR, but which is not definite due to relatively low level of evidence. |
1.1.5. Sun 2009 (versus traction) ☆
Sun P, Du YH, Xiong J et al. [Acupuncture versus traction for cervical spondylotic radiculopathy: a systematic review]. Guangming Journal of Traditional Chinese Medicine. 2009. 24(10):1824–1830.[187023].
| Objective | To assess the efficacy of acupuncture versus traction in the treatment of Cervical Spondylotic Radiculopathy. |
| Methods | Randomized controlled trials (RCTs)involving acupuncture versus traction in the treatment of Cervical Spondylotic Radiculopathy were searched from PubMed (1950 to 2008)、Ovid (1950 to 2008)、EBSCO (1973 to 2008)、Cochrane Library (Issue 2, 2008)、CBM (1978 to 2006)、CNKI (1979 to 2008)、VIP (1989 to 2008) and WANFANG Database (1998 to 2008). We also hand searched relevant journals and conference proceedings. Data were extracted and evaluated by two reviewers independently with a specially designed extraction form. The Cochrane Collaboration’s RevMan 4. 2. 8 software was used for data analyses. |
| Results | A total of 8 trials involving 1546 patients were included. Effective rate was used as the primary resultant index in all the eight syudies. Meta-analyses showed that effective rate between acupuncture group and traction group was significant difference [RR 1. 24, 95%CI (1. 16 to 1. 32)], significant difference was also noted when acupuncture plus traction group versus traction group [RR1. 10, 95%CI (1. 02 to 1. 18)]. MPQ score was used as the secondary resultant index in these three studies, there were significant differences between treatment group and control group as for VAS [WMD 1. 53, 95%CI (0. 85 to 2. 21)]and PPI [WMD 0. 61, 95%CI (0. 50 to 0. 71)]. |
| Conclusion | Acupuncture treatment is effective for Cervical Spondylotic Radiculopathy and is superior to traction in the aspects of effective rate and pain alleviating. The curative effect of traction treatment could be improved when combining with acupuncture. However, the conclusion was uncertain because the quality of enrolled papers was partly low. Therefore, further high-quailty randomized controlled trials are required to prove the role of acupuncture in the treatment of Cervical Spondylotic Radiculopathy. |
1.2. Special Acupuncture Techniques
1.2.1. Moxibustion
1.2.1.1. Zhang 2016 ☆
Zhang Yang , Zhou Mei-qi ,Tang Wei , Song Xiao-ge. System evaluation and Meta analysis on clinical efficacy of heat-sensitive moxibustion in treatment of cervical spondylotic radicuiopathy World Journal of Acupuncture of Moxibustion. 2016;26(4):41. [178238].
| Objectives | To systematically evaluate the efficacy of heat-sensitive moxibustion in treatment of cervical spondylotic radiculopathy (CSR). |
| Methods | Chinese National Knowledge Infrastructure (CNKI), China Biology Medical (CBM) database, Chinese Science and Technology Periodical Database (VIP), WanFang Data, Pubmed and Cochrane Library were retrieved to search the randomized controlled trials (RCT) on heat-sensitive moxibustion in treatment of CSR, and Meta analysis was conducted by applying RevMan 5.3 software. |
| Results | Eventually, 10 papers were included in this study, including 1008 subjects. Meta analysis result showed: the total effective rate of treatment group was higher than that of control group, and the difference was statistically significant [RR=1.13, 95%C1(1.06, 1.21), Z=3.54, P=0.000 4]; the cure rate of treatment group was higher than that of control group, and the difference was statistically significant [RR=1.80, 95%C1(1.52, 2.13), Z=6.82, P<0.000 01]; the improvement of short-form McGill pain questionnaire (SF-MPQ) of treatment group was superior to that of control group, and the difference was statistically significant [MD=-4.44, 95%Cl(-6.38, -2.50), Z=4.49, P<0.000 01]; visual analogue scale (VAS) of treatment group was lower than that of control group, and the difference was statistically significant [MD=-0.36, 95%Cl(-0.50, —0.23), Z=5.42, P<0.00001]; and the improvement of interleukin-6 (IL-6) of treatment group was superior to that of control group, and the difference was statistically significant [MD=-7.32, 95%Cl(-11.49, —3.14), Z=3.44, P=0.000 6]. |
| Conclusions | It is indicated from the Meta analysis result that the clinical efficacy of heat-sensitive moxibustion or acupuncture combined with heat-sensitive moxibustion in treatment of CSR is superior to that of simple acupuncture or traditional suspended moxibustion, providing a new therapeutic method for treatment of CSR. However, the above mentioned conclusion still needs to be confirmed through randomized blind controlled trials with high quality and large sample size since the sample size of included studies was small, and the quality was low. |
1.2.2. Acupotomy
1.2.2.1. Zhao 2016
Zhao Meimei, Liu Fushui, Hong Tao, Zhou Fanzuo, Xie Hongwu. [Systematic review of acupotomy in the treatment of cervical spondylotic radiculopathy]. Traditional Chinese Medicine Journal (中医药通报). 2016;15(4):40-2;45. [182982].
| 系统评价针刀治疗神经根型颈椎病的临床疗效及其安全性。方法：计算机检索中国知网(1979-2015)、维普(1989-2015)、中国生物医学文献数据库(1978-2015)、Cochrane Library(2015年第4期)和美国图书馆PubMed (1966-2015),辅以手工检索相关论著及期刊,按照Cochrane系统评价员手册5.3的要求,采用RevMan5．3．0软件进行数据分析。结果：纳入7项临床随机对照试验,共941例神经根型颈椎病患者,Meta分析结果显示针刀组治疗神经根型颈椎病临床总有效率、治愈率高于其它治疗方式。针刀组报道了2例中等程度的不良反应,均为非直视下针刀进至神经根管内口进行铲切剥离操作时,突然出现剧烈的窜麻感。结论：临床治疗神经根型颈椎病可优先选择针刀疗法,同时应进一步改善针刀的可视性操作,提高其安全性；本研究纳入临床随机对照试验数量少且质量不高,建议在临床上设计并开展较为严格及完善的随机对照试验来验证上述结论. |
| Objective | Systematic review of the clinical efficacy and safety of needle knife in the treatment of cervical spondylotic radiculopathy. |
| Methods | Computer search of China HowNet (1979-2015), Weipu (1989-2015), Chinese Biomedical Literature Database (1978-2015), Cochrane Library (2015 Issue 4), and American Library PubMed (1966-2015) Relevant manuals and journals were supplemented by manual retrieval. According to the requirements of Cochrane systematic reviewer manual 5.3, RevMan 5.3.0 software was used for data analysis. |
| RESULTS | Seven randomized controlled trials were included. A total of 941 patients with cervical spondylotic radiculopathy were included. The meta-analysis showed that the total effective rate and cure rate of the needle-knife group in treating cervical spondylotic radiculopathy were higher than other treatment methods. The needle-knife group reported two cases of moderate-level adverse reactions. Both of them experienced a sharp numbness when they went to the inner root of the nerve root canal for cutting and stripping. |
| CONCLUSION | Needle-knife therapy should be preferentially selected for clinical treatment of nerve root type cervical spondylosis. At the same time, the visibility operation of needle-knife should be further improved to improve its safety. The number of randomized controlled trials included in this study is small and the quality is not high. Designed and carried out a more rigorous and complete randomized controlled trial to verify the above conclusions |
1.2.2.2. Liu 2007 Ø
Liu XQ, Deng JF, Lin DK. [The evaluation of clinical articles about cervical spondylotic radiculopathy treated with acupotomy]. Chinese Journal of Traditional Medical Traumatology & Orthopedics 2007.15(4):34–37. [168341].
| Objective | To evaluate the quality of clinical study and efficacy of the treatment for cervical spondylotic radiculopathy(CSR)by acupotomy. |
| Methods | Dialog Online Retrieval system was used, extracting targeted articles were selected about the treatment in CSR by acupotomy assessed. Grades of recommendation and level of evidence to evaluate and compare the methodological quality in these articles, and the efficacy in the treatment for CSR by acupotomy. |
| Results | Seventy-six articles were evaluated 12 randomized controlled trials, 8 non- randomized controlled trials and 56 clinical retrospective studies. The grades of evidence recommendation and the frequency: B level 12, C level 8, D level 56.The level of evidence and the frequency: 2a level 2, 2b level 4, 4 level 8, 5 level 56.The methodological quality and the frequency of 20 clinical controlled trials: diagnostic criteria, 13A, 7B.The inclusive criteria, 5A, 15C; exclusive criteria, 7A, 13C; randomized method, 7A, 5B, 8C; base line, 9A, 11C; follow-up, 1A, 19C;therapeutical effect, 6A, 13B; statistical algorithm, 9A, 11B; the sample evaluation, the randomized assignment protocol hiding, blind trial and lost to follow are 20C. The total effective rate was 80%～100%; Three results of the Meta-analysis about these clinical controlled trial: there is a great difference between the treatment of acupuncture and acupotomy; the group of acupotomy is better than that of acupuncture; there`s no damage on the nerve or on the circulation system, or fainting during the treatment,etc. |
| Conclusions | There is no enough high grades of evidence recommendation. the level of evidence is rather low; there`s some defects in clinical study on the treatment for CSR by acupotomy; treatment for CSR by acupotomy is safe and efficient treatment for CSR, but the bad quality of articles and the deficiency of methodological decline the efficacy and the reliability. |
1.2.3. Chimio-acupuncture
1.2.3.1. Zhang 2019
Zhang Wanjuan, Fu Fangling, Li Wu, Jiang Quanrui, Feng Xiang, Zhang Yuxing, Li Jiangshan. [Meta Analysis on the Clinical Effect of Acupuncture and Moxibustion Combined with Acupoint Injection in the Treatment of Cervical Spondylotic Radiculopathy]. Chinese Medicine Modern Distance Education of China. 2019;7:62-65. [201725].
的 对目针灸配合穴位注射治疗神经根型颈椎病临床随机对照试验进行临床疗效与方法 学质量评价.方法 登录中国知网(CNKI)、万方数据知识服务平台、维普网(VIP),计算机检索针灸配合穴位注射治疗神经根型颈椎病的相关文献,将得到的文献进行筛选、剔除后,使用RevMan 5.3软件进行Meta分析.结果 Meta分析结果 显示,针灸配合穴位注射治疗神经根型颈椎病总有效率的合并OR=4.04,95％CI[2.81,5.83],Z=7.5,VAS改善值比较合并的MD为-1.06,95％置信区间为[-1.73,-0.39],合并影响Z=3.1.结论 本研究结果 表明针灸配合穴位注射治疗CSR具有较好的临床疗效,可以改善疼痛症状,提高生活质量,且优于常规针刺、温针灸及推拿等.
| [Automatic translation]. |
| Objective | To evaluate the clinical efficacy and methodological quality of acupuncture combined with acupoint injection in the treatment of cervical spondylotic radiculopathy. |
| Methods | The method was applied to China Knowledge Network (CNKI), Wanfang Data Knowledge Service Platform, VIP Network (VIP), computer search for acupuncture. Combined with acupoint injection for the treatment of cervical spondylotic radiculopathy, the selected literature was screened and rejected, and meta-analysis was performed using RevMan 5.3 software. |
| Results | The results of meta-analysis showed that the total effective rate of acupuncture combined with acupoint injection for cervical spondylotic radiculopathy The combined OR=4.04, 95% CI [2.81, 5.83], Z=7.5, the VAS improvement value is compared with the combined MD of -1.06, the 95% confidence interval is [-1.73, -0.39], and the combined effect is Z=3.1. |
| Conclusions | The results of this study indicate that acupuncture combined with acupoint injection for CSR has a good clinical effect, can improve pain symptoms, improve quality of life, and is superior to conventional acupuncture, warm acupuncture and massage. |
1.2.4. Wrist-ankle Acupuncture
1.2.4.1. Fu 2018 ☆
Fu Yingyue, Dong Longcong, Pan Jianxiang, Xiang Kaiwe. [A Meta-analysis on Treating Cervical Spondylotic Radiculopathy with Wrist-ankle Acupuncture and its Combination Therapy]. Journal of Guiyang University of Chinese Medicine. 2018;05:. [181223].
| Objective | To evaluate the clinical efficacy of treating cervical spondylotic radiculopathy with wrist-acupuncture therapy and its combination therapy. |
| Methods | CNKI, WANGANG, CBM, Pub Med, Embass, and Medline databases were retrieved. The retrieval time is from the time the database was built to May2018. Two researchers screened the literature independently, extracted literature data, assessed the risk of bias and analyzed the data by using Rev Man 5. 3 software. |
| Results | A total of 12 RCTs were included in 979 cases, with 510 cases in the test group and 469 cases in the control group. The results of the meta-analysis showed that 10 studies indicated that the efficiency of the wrist-ankle acupuncture and its combination therapy group was higher than that of the non-wrist-ankle acupuncture group [OR = 2. 79, 95% CI( 1. 87, 4. 16), P < 0.00001], and the efficiency of the simple-use-wrist-ankle acupuncture group was as good as that of the non-wrist-ankle acupuncture group [OR = 0. 75, 95% CI( 0. 24, 2. 31), P = 0. 62 ], while the efficiency of the combined therapy group was superior to that of the non-wrist-ankle acupuncture group [OR = 3. 14, 95%CI( 1. 99, 4. 97), P < 0. 00001]. 8 studies indicated that the improvement of VAS scores of the wrist-ankle acupuncture group and its combination therapy group was better than that of the non-wrist-ankle acupuncture group [WMD =-1. 06, 95% CI(-1. 69-0. 43), P = 0. 001]. |
| Conclusion | The wrist-ankle acupuncture and its combination therapy are more advantageous than the wrist-ankle acupuncture therapy in treating the disease and its clinical efficiency. However, limited by the quality and quantity of the included studies, the conclusions of this study may be biased, and more high-quality researches should be done to verify it. |
1.2.5. Cervical Three-needle Acupuncture
1.2.5.1. Yin 2020
Yin Yueshan. [Meta-analysis of acupuncture with three cervical acupuncture for the treatment of cervical spondylotic radiculopathy]. The Journal of Cervicodynia and Lumbodynia. 2020. [212894].
| Objective | To systematically evaluate the effectiveness and safety of cervical three-needle acupuncture for the treatment of cervical spondylotic radiculopathy (CSR). |
| Methods | The computer searched Wanfang, HowNet, Weipu, Pubmed, Highwire, Springer, EBSCO and other databases, randomly collected the relevant randomized controlled research literature of cervical three-needle + other therapies, after evaluating the quality of the literature, Revman5. 3 was used for data analysis. |
| Results | A total of 10 randomized controlled studies were included. The clinical effective rate [OR=3. 79 (95%CI: 2. 49～5. 78), P<0. 001] of patients treated with cervical three-needle therapy was significantly higher than that of patients without cervical three-needle therapy. The VAS score (WMD =-1. 38, 95%CI is -1. 62～-1. 13, P<0. 001), NDI (WMD=-9. 23, 95%CI is -18. 20～-0. 25, P<0. 04) is significantly lower than that of non-neck three-needle patients . None of the literature reports the incidence of adverse reactions. |
| Conclusion | Cervical three-needle acupuncture treatment of CSR can improve the clinical effectiveness, reduce the level of pain, and reduce the degree of cervical spine dysfunction. Its safety needs further research. |
1.2.6. Catgut Embedding
1.2.6.1. Liang 2020
Liang Long. [Systematic Review of Acupoint Embedding Treating for Cervical Radiculopathy ]. Guiding Journal of TCM and Pharmacy. 2020. [212900].
| Objective | To systematically evaluate the efficacy and safety of acupoint embedding in the treatment of cervical radiculopathy. |
| Methods | All randomized controlled trials of acupoint embedding in the treatment of cervical spondylotic radiculopathy were retrieved by computer. The quality assessments were performed using the Cochrane risk of bias tool. Meta-analysis was carried out with RevMan 5. 3 and Stata 12. 0 software. |
| Results | A total of nine articles were included and 1128 cases were studied. The results showed that acupoint embedding could improve clinical efficacy better than acupuncture and electro-acupuncture [OR =3. 85, 95% CI (2. 35, 6. 31), P <0. 000, 01]. In terms of improving VAS score, acupoint embedding is better than ordinary acupuncture[SMD=-1. 19, 95%CI (-1. 85, -0. 53), P=0. 000, 4]; in terms of improvement of NDI index, the acupoint embedding is superior to acupuncture [SMD=-0. 61, 95%CI (-1. 08, -0. 14), P=0. 01] in trems of improving Tianzhong Jingjiu scale, the acupoint embedding is superior to acupuncture and electro-acupuncture groups [SMD=1. 31, 95%CI (0. 89, 1. 73), P<0. 000, 01]; In terms of safety, the number of adverse reactions that occur after acupoint embedding was more than that of acupuncture. |
| Conclusion | Acupoint embedding can effectively alleviate the pain of patients with cervical radiculopathy, improve the functional status of patients and improve clinical efficacy, but the safety is lower than that of acupuncture. |
1.2.7. Abdominal acupuncture
1.2.7.1. Peng 2023
Peng Y, Wu J, Wu Y, Chen F. Abdominal acupuncture therapy for cervical spondylotic radiculopathy: A systematic review and metaanalysis. Asian J Surg. 2023 Dec;46(12):5776-5778. https://doi.org/10.1016/j.asjsur.2023.08.138
2. Overviews of Systematic Reviews
2.1. Wei 2015
Wei X, Wang S, Li J, Gao J, Yu J, Feng M et al. Complementary and alternative medicine for the management of cervical radiculopathy: an overview of systematic reviews. Evid Based Complement Alternat Med 2015. [183367].
| Background | Complementary and alternative medicine (CAM) is widely applied in the clinical practice of neck pain owing to cervical radiculopathy (CR). While many systematic reviews exist in CAM to improve CR, research is distributed across population, intervention, comparison, and setting. |
| Objective | This overview aims to summarize the characteristics and evaluate critically the evidence from systematic reviews. |
| Methods | A comprehensive literature search was performed in the six databases without language restrictions on February 24, 2015. We had identified relevant systematic reviews that examined the subjects with neck pain due to cervical radiculopathy undergoing CAM. Two authors independently appraised the methodological quality using the revised assessment of multiple systematic reviews instrument. |
| Results | We had included eight systematic reviews. The effectiveness and safety of acupotomy, acupuncture, Jingfukang granule, manual therapies, and cervical spine manipulation were investigated. Based on available evidence, the systematic reviews supported various forms of CAM for CR. Nevertheless, the methodological quality for most of systematic reviews was low or moderate. In addition, adverse reactions of primary studies were infrequent. |
| Conclusions | Current systematic reviews showed potential advantages to CAM for CR. Due to the frequently poor methodological quality of primary studies, the conclusions should be treated with caution for clinical practice. |
3. Clinical Practice Guidelines
⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation (or lack of evidence) |
3.1. Danish Health and Medicines Authority (DHMA, Danemark 2016) Ø
Danish Health and Medicines Authority. National clinical guideline for the non-surgical treatment of recent onset nerve root compromise in the neck with symptoms radiating to the arm (cervical radiculopathy). Copenhagen: Danish Health and Medicines Authority. 2016.
2P . [195992].
| It is not good practice, on a routine basis, to offer acupuncture to patients with recent onset cervical radiculopathy as an add-on to other treatment. |
Kjaer P, Kongsted A, Hartvigsen J, Isenberg-Jørgensen A, Schiøttz-Christensen B, Søborg B, Krog C, Møller CM. National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. Eur Spine J. 2017;26(9):2242-2257. [178861].
| For treatment, guidelines suggest acupuncture for neck pain but not for cervical radiculopathy. |
3.2. American College of Occupational and Environmental Medicine (ACOEM, USA 2011) Ø
American College of Occupational and Environmental Medicine (ACOEM). Cervical and thoracic spine disorders. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM). 2011; 332P. [166312].
| Radicular Pain Syndromes. Not recommended: Routine use of acupuncture for acute radicular pain (I) |
