Cervical radiculopathy

Cervical radiculopathy is pain, numbness or weakness that runs from the neck into the shoulder and arm because a nerve root in the neck is compressed or inflamed. In Chinese trials the usual term is cervical spondylotic radiculopathy, where the compression comes from degenerative change in the discs and joints of the neck, most often at the C7 root and then C6, as a 2024 review by Zhao and colleagues notes. Trials score pain on a visual analogue scale (VAS), disability on the Neck Disability Index (NDI), and many Chinese trials report a total effective rate, the share of patients the investigators judged improved. Neck pain without a trapped nerve is covered in Neck pain, and Sham acupuncture explains the controls that mimic needling.

Is there a Cochrane review?

Cochrane has no review of acupuncture for cervical radiculopathy alone. Its review of acupuncture for neck disorders treated nerve root involvement as one subgroup. The 2006 version by Trinh and colleagues covered 10 trials of chronic neck pain and found moderate evidence that, for chronic neck disorders with radicular symptoms, acupuncture did better than a waiting list at short-term follow-up. The 2016 update put two trials with 43 participants in that subgroup, stated no separate finding for them in its abstract, and was withdrawn from the Cochrane Library in November 2016; the Neck pain page describes the withdrawal.

Reviews of cervical radiculopathy

The 2024 review by Zhao and colleagues found a higher total effective rate with acupuncture than with traction (risk ratio 1.14) and lower pain scores, and concluded that acupuncture was more effective than traction. One of its 27 trials blinded the people assessing outcomes, and the points, their number and the needling depth varied between trials. Courses lasted 10 to 45 days. One trial reported three cases of needle sickness, a fainting reaction, and others reported minor pain and bleeding at the needle sites, none affecting vital signs.

The 2024 network meta-analysis by Lin and colleagues compared methods that no single trial had set side by side. On pain scores it ranked acupoint catgut embedding, Fu’s subcutaneous needling and needle knife above conventional acupuncture, and conventional acupuncture above electrotherapy and sham needling; on the NDI it ranked needle knife first. One of its 28 trials had a sham-needle arm. The authors reported that only 2 trials described concealing allocation, none was blinded, most interventions rested on very few trials, and the funnel plot was asymmetric, a sign that small positive trials may be over-represented. The 2025 network meta-analysis by Zhao and Yang ranked acupuncture with warm needling highest for clinical response, with credible intervals as wide as 1.98 to 563.78 around its risk ratios. Its authors noted that almost no included trial used blinding, follow-up varied, and few trials recorded adverse events.

The 2026 review of needle-knife therapy by Zhang and colleagues, needle knife meaning a needle with a flat cutting tip also called acupotomy, found higher effective rates and lower pain and disability scores than with the comparison treatments. Heterogeneity, the disagreement between trials beyond chance, reached I² 99% for pain, and the authors called the findings preliminary.

Two reviews assess the evidence as a whole. The 2025 overview by Chen and colleagues assessed six Chinese reviews, including Zhao’s, with AMSTAR 2, a tool for judging how well a review was conducted, and rated all six critically low; none had assessed the certainty of its own evidence. Limitations in trial design lowered every outcome’s grade and suspected publication bias lowered 92.7% of them, and the overview found that the safety of acupuncture for the condition had not been systematically evaluated. The 2023 review by Plener and colleagues admitted only trials that confirmed the diagnosis by examination or tests, could not pool them, and found very low certainty evidence supporting acupuncture, prednisolone, cervical manipulation and low-level laser therapy for pain and disability in the immediate to short term.

Trials outside China

A 2026 pilot trial by Cho and colleagues at Pusan National University Korean Medicine Hospital randomised 32 people with degenerative cervical radiculopathy, confirmed clinically and on imaging, to ultrasound-guided acupotomy or to interferential current with microwave heating, twice a week for three weeks. At week 4 neck pain was 25.7 mm lower and arm pain 18.7 mm lower on the 100 mm VAS in the acupotomy group. Mild, self-limiting adverse events followed 5 of 96 acupotomy sessions. Neither patients, practitioners nor assessors were blinded, follow-up lasted 8 weeks, and the authors called for larger confirmatory trials.

What guidelines say

The North American Spine Society’s 2010 guideline on cervical radiculopathy from degenerative disorders, summarised by Bono and colleagues in 2011, covers literature to May 2009. Its full text asks about ancillary treatments including acupuncture; the work group’s consensus answer names ozone injections, halter traction and combined programmes, all from uncontrolled case series, and cites no study of acupuncture. The society’s guideline list still shows the 2010 edition as completed, with no revision in progress.

Danish national guidelines, summarised in 2017 by Kjaer and colleagues, covered radiculopathy of less than 12 weeks. The working group found no randomised trials of acupuncture for it and stated by consensus that acupuncture should not routinely be added to other treatment, while making a weak recommendation for acupuncture in recent-onset neck pain without radiculopathy. NICE’s Clinical Knowledge Summary on cervical radiculopathy, last revised in November 2023, advises reassurance, activity, painkillers, neuropathic pain drugs and physiotherapy for symptoms of under 4 to 6 weeks without objective neurological signs, and otherwise referral for MRI and consideration of injections or surgery; it does not mention acupuncture.

The China Association of Chinese Medicine’s 2025 guideline on Chinese medicine for cervical radiculopathy, with evidence searched to February 2023, makes a strong recommendation for manual acupuncture on moderate certainty evidence and a weak one for electroacupuncture on low certainty evidence. Both rest on trials against conventional Western treatment such as traction and drugs: in 7 trials with 499 patients, VAS pain was 1.61 points lower with manual acupuncture than with Western treatment. Four of the trials behind these recommendations name in their titles the neck Jiaji points, the points beside the cervical vertebrae that the catalogue codes XB02C1 to XB02C7 (Huatuo Jiaji).

Clinical guidelines compares positions across conditions.

What the reviews could not settle

No review has pooled sham-controlled trials of cervical radiculopathy, so the reviews cannot say how much of the difference against traction, drugs or physiotherapy comes from needling itself. Almost every trial was run in China, few were blinded, and many measured a total effective rate that the investigators judged themselves; Where the trials come from discusses what that means for a reader. Treatment courses in the traction comparisons lasted weeks, the 2025 network meta-analysis asked for longer follow-up, and the reviews could not say whether any benefit lasts. Adverse events went largely unrecorded. The network meta-analyses rank a dozen needling methods on a few trials each, and the guidelines disagree: the Chinese guideline recommends acupuncture strongly, the Danish one advises against routine use in recent-onset radiculopathy, and the North American and NICE guidance cite no acupuncture evidence at all.

AcuiQ’s cervical spondylotic radiculopathy page lists the protocols individual studies prescribed, each with its citation. Sciatica and disc herniation covers the same nerve root problem in the lower back, and Carpal tunnel syndrome covers a compressed nerve at the wrist that also causes numbness in the hand.