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

Objective: To explore the effectiveness of needle-knife therapy for lumbar disc herniation and its advantages compared with traditional treatments. Methods: 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. Results: 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, I 2 = 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, I ² = 93%, JOA: MD = 2.93, 95% CI: 1.88–3.98, P = .0001, I ² = 0%, ODI: MD = −4.93, 95% CI: −5.68 to −4.18, P = .0001, I 2 = 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, I 2 = 0%, VAS: MD −1.12, 95% CI: −1.23 to −1.01, P = .0001, I 2 = 99%, JOA: MD = 3.73, 95% CI: 3.0–4.45, P = .0001, I 2 = 0%). Sensitivity analysis showed no significant reversal, indicating the reliability of the included results. Conclusion: 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.