PURPOSE: Chronic spinal musculoskeletal pain (CSP) is a prevalent and disabling condition affecting hundreds of millions worldwide. Ultrasound-guided acupotomy (UGA) has emerged as a minimally invasive intervention for CSP. This study aimed to systematically evaluate the efficacy and safety of UGA for CSP through a meta-analysis of randomised controlled trials (RCTs).
PATIENTS AND METHODS: The study protocol was prospectively registered with PROSPERO (CRD420251156718). A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and VIP Database from inception to August 2025 for RCTs. Primary outcomes included pain intensity assessed by the Visual Analogue Scale (VAS), functional disability assessed by the Neck Disability Index/Oswestry Disability Index (NDI/ODI) and the Japanese Orthopaedic Association (JOA) score, and overall clinical response rate. Secondary outcomes included recurrence rate and incidence of adverse events. Methodological quality was assessed using the modified Jadad scale, Cochrane risk of bias tool, and GRADE system. Meta-analysis, subgroup analysis, sensitivity analysis, and publication bias assessment were performed.
RESULTS: A total of 32 RCTs involving 2669 participants were included, all conducted in China and published between 2014 and 2025, covering spinal conditions including cervical spondylosis, lumbar disc herniation, cervicogenic headache, ankylosing spondylitis, and related disorders. UGA showed significant advantages over control groups in reducing pain intensity (VAS: SMD = -0.80, 95% CI: -0.97 to -0.64) and improving functional outcomes (NDI/ODI: SMD = -0.99, 95% CI: -1.36 to -0.63; JOA score: SMD = 0.77, 95% CI: 0.43 to 1.12), along with a higher overall response rate (RR = 1.15, 95% CI: 1.12-1.19). A trend toward reduced recurrence was observed (RR = 0.63, 95% CI: 0.27-1.43), though this did not reach statistical significance. Adverse events in the UGA group were mild and less frequent (0%-13.8%) than controls (0%-51.7%). Subgroup analysis revealed that add-on UGA therapy yielded optimal outcomes with low heterogeneity. Evidence quality was moderate for pain and response rate, and low for other outcomes. It should be noted that all 32 included RCTs were conducted in China, which may limit the generalisability of these findings to other geographic and clinical contexts.
CONCLUSION: UGA appears to be an effective and safe intervention for CSP, with particular benefit observed when used as an add-on therapy. However, given the moderate to low certainty evidence, high heterogeneity, and predominant risk of bias due to lack of blinding, these results should be interpreted with caution. Further high-quality multicentre RCTs with standardised protocols are warranted to confirm these findings.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
UGA could be a reasonable and minimally invasive option for chronic spinal musculoskeletal pain, best integrated alongside physiotherapy, therapeutic exercise, and/or pharmacotherapy rather than replacing them. However, all RCTs were conducted in China, with moderate-to-low certainty evidence, substantial operator dependence, poor blinding, and the follow-up rarely exceeded 6 months. Wider adoption will require operator training standards, sham-controlled multicenter trials, and longer follow-up periods.
Physician rater
UGA achieved a significant pooled VAS reduction with a favourable safety profile, as most adverse events were minor. Real-time imaging helps prevent neurovascular injuries. Limitations include reliance on Chinese RCTs only, methodological concerns such as inadequate randomization and blinding, short follow-up periods, and heterogeneity unexplained by subgroup analysis. The operator-dependent nature of the technique challenges reproducibility outside of specialized centres.
, McMaster University