Acupotomy for Military Training-Induced Lumbar Radiculopathy with Sciatica: Protocol of a Randomized Controlled Trial

Military personnel face elevated risks of chronic sciatica due to repetitive mechanical loading during combat training. Conventional therapies, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy, often fall short in addressing the urgent need for rapid functional recovery. Acupotomy, a minimally invasive technique that integrates acupuncture with microsurgical dissection, has the potential to alleviate both central and peripheral nerve compression; however, its efficacy within military populations remains inadequately studied. This single-center, parallel-group randomized controlled trial will enroll 80 active-duty military personnel (aged 18-45 years) with MRI-confirmed L4-S1 lumbar disc herniation and sciatica for at least three months. Participants will be randomly assigned in a 1:1 ratio to receive either ultrasound-guided acupotomy (administered once a week for a total of four sessions) or sham acupotomy. The primary outcomes will include leg pain intensity, measured using the Visual Analogue Scale (VAS), and functional disability, assessed via the Oswestry Disability Index (ODI). Secondary outcomes include lumbar function (as measured by the Japanese Orthopaedic Association scale), blinding efficacy, and adverse events. This study aims to provide high-quality evidence for the treatment of military training-related sciatica with acupotomy via a rigorous RCT design. If the results confirm its efficacy and safety, it could address multiple levels of nerve compression in ≤4 weeks, thereby redefining nonsurgical therapies in direct support of combat readiness. Future studies should expand the scope of the study and deepen the mechanism exploration to promote its application in a wider range of clinical scenarios. This protocol has been registered at ITMCTR (No. 2025000628. Registered on: 1 April 2025).