Effects of Acupotomy Treatment for Lumbar Spinal Stenosis: A Systematic Review and Meta Analysis

요추관 협착증에 대한 침도치료의 효과: 체계적 문헌고찰 및 메타분석

Objectives This study aimed to provide evidence on the effects and safety of acupotomy treatment for lumbar spinal stenosis. Methods We searched 10 databases (PubMed, Cochrane Library, Embase, China Academic Journals, VIP Chinese science journals, Wanfang, DBpia, Oriental medicine Advanced Searching Integrated System, Research Information Sharing Service, Korean studies Information Service System) up to July 31, 2025 without restrictions. Randomized controlled trials (RCTs) assessing acupotomy alone or as a combination therapy for lumbar spinal stenosis were included. The risk of bias of RCTs was assessed using the Cochrane tool. Results 14 eligible RCTs were included. Compared with acupuncture, acupotomy significantly improved visual analogue scale score (VAS) (standardized mean difference, SMD; -2.42 [95% confidence interval, CI; -4.49 to -0.34], p=0.02) and Japanese Orthopaedic Association score (JOA) (SMD 1.69 [95% CI, 0.12 to 3.26], p=0.03). Against caudal epidural block, acupotomy showed benefits in VAS (SMD -1.19 [95% CI, -1.86 to -0.52], p=0.0005) and total efficacy rate (TER) (relative risk, RR; 1.25 [95% CI, 1.13 to 1.39], p<0.0001). Compared with manipulative therapy, TER favored acupotomy (RR 1.23 [95% CI, 1.07 to 1.41], p=0.003) with additional improvements in VAS and JOA in some studies. Most combination therapy trials showed no significant differences, except for acupotomy plus electroacupuncture and manipulative therapy which improved VAS, JOA, and Oswestry disability index. Safety was reported in only five studies, with few adverse events and no significant differences between groups. Conclusions Acupotomy appears to be a safe and effective minimally invasive treatment for lumbar spinal stenosis. However, large-scale, high-quality randomized controlled trials are needed to strengthen the level of evidence and to clarify the clinical role of acupotomy in lumbar spinal stenosis management, particularly regarding combination therapies used in clinical practice.