Effectiveness of Acupotomy Combined with Epidural Steroid Injection for Lumbar Radiculopathy: A Systematic Review and Meta-Analysis

Introduction: Acupotomy—a combination of acupuncture and minimally invasive surgery—is a commonly used traditional East Asian medical intervention for treating patients with lumbar radiculopathy (LR). In this study, we aimed to evaluate whether a combination of acupotomy and epidural steroid injections (ESIs) was more effective than ESIs alone or ESIs along with interventions other than acupotomy for LR patients.
Methods: Randomized controlled trials (RCTs), which used acupotomy and ESIs in patients with LR, were retrieved from thirteen databases on June 10, 2024 (PROSPERO CRD42023435441). Outcomes were assessed using the pain Visual Analogue Scale (VAS), total effective rate (TER), Oswestry Disability Index (ODI) and adverse events (AEs). Cochrane’s Risk of Bias Tool 2 (RoB2) was employed to assess the risk of bias in the studies. The Grading of Recommendations, Assessment, Development, and Evaluation tool was also used to assess the quality of the evidence.
Results: Five studies involving 577 patients were included in this review. Compared with ESIs alone, a combination of acupotomy and ESIs led to improvement in pain VAS scores (Three RCTs, standard mean difference [SMD] −0.73 [−1.01 to −0.45], very low certainty of evidence [CoE]) and TER (Four RCTs, risk ratio 1.31 [1.02 to 1.69], very low CoE), although most studies were evaluated as high risk in the RoB2 evaluation. However, the combination showed no improvement in ODI (Two RCTs, SMD 0.46 [−1.58 to 2.50], very low CoE). There were no major AEs.
Conclusion: Although the quality of the evidence was very low, combined acupotomy and ESIs proved more effective than ESIs alone for LR patients. Further rigorously designed studies are warranted to confirm the effects of combination therapy on LR patients.