Needle-knife therapy beats acupuncture for lumbar disc herniation in randomized trial

For millions of people living with the shooting leg pain of lumbar disc herniation, treatment options often feel like a choice between two imperfect paths: conservative therapies such as acupuncture that may provide only partial relief, or invasive procedures that carry real risks. A research team in China has now reported results from a randomized controlled trial suggesting that a third option — a minimally invasive technique known as needle-knife lumbosacral therapy — may outperform conventional acupuncture on both pain and disability. The study, published in Frontiers in Neurology, was conducted as an outcome assessor-blinded trial at a single center and registered in a public clinical trial registry.

Lumbar disc herniation is one of the most common causes of low back and radiating leg pain worldwide. The condition arises when the gel-like nucleus pulposus at the center of an intervertebral disc pushes through fissures in the tough annulus fibrosus, often posterolaterally, compressing nerve roots. That mechanical compression is only part of the story: the protruding tissue also releases inflammatory mediators such as interleukin-6, tumor necrosis factor-alpha, and prostaglandin E2, which drive nerve root sensitization, ischemia, and pain. The result is pain that worsens with coughing, sneezing, or prolonged sitting and can severely limit daily life.

Needle-knife therapy is a minimally invasive technique that combines the fine needle of acupuncture with a small flat blade at the tip. In the trial, the needle knife was inserted at specific lumbosacral sites — including the paravertebral regions of the third through fifth lumbar vertebrae and the sacral foramina — and advanced through three soft-tissue layers. At each layer, the practitioner performed longitudinal cutting and transverse stripping maneuvers designed to release adhesions, reduce soft-tissue tension, and improve local circulation. The technique is intended to address the soft-tissue component of disc-related pain that conventional acupuncture may not fully reach.

The trial enrolled 74 patients with lumbar disc herniation confirmed by imaging and clinical examination, randomized them in a 1:1 ratio to receive either needle-knife therapy or conventional acupuncture, and assessed outcomes by assessors blinded to group assignment. The primary outcomes were pain intensity measured on the visual analog scale and functional disability measured with the Oswestry Disability Index, evaluated before treatment, immediately after the two-week treatment course, and at follow-up. Secondary outcomes included lumbar range of motion and serum levels of the inflammatory markers interleukin-6, interleukin-1 beta, and tumor necrosis factor-alpha.

Both groups improved over the treatment period, but the needle-knife group showed significantly larger reductions in pain and disability. Immediately after treatment, the needle-knife group had a mean visual analog scale score of 2.16 compared with 3.34 in the acupuncture group, and a mean Oswestry Disability Index of 12.32 compared with 21.44. The between-group differences remained statistically significant in mixed-effects models that accounted for repeated measurements within patients. Lumbar flexion range of motion also improved more in the needle-knife group, although the authors noted that this outcome was assessed as a secondary measure.

Of the three inflammatory markers measured, only interleukin-6 showed a statistically significant greater decrease in the needle-knife group compared with acupuncture, with a mean difference of −0.46 picograms per milliliter (95% confidence interval −0.87 to −0.05). Interleukin-1 beta and tumor necrosis factor-alpha showed numerical decreases in the needle-knife group that did not reach statistical significance. The authors interpreted the interleukin-6 finding as consistent with the hypothesis that needle-knife therapy reduces local inflammatory activity, while cautioning that the marker results should be viewed as exploratory.

No serious adverse events were reported in either group. Common adverse effects were mild and transient, including local soreness at the needle insertion sites and minor bruising. The needle-knife group did not show a higher rate of adverse events than the acupuncture group, an important consideration for a technique that involves deliberate soft-tissue cutting maneuvers.

The authors emphasized several strengths of the trial, including the blinded outcome assessment, the use of a registered protocol with predefined primary outcomes, and the application of a multiple-comparison correction across the three repeated outcomes. They also acknowledged limitations: the trial was conducted at a single center, the sample size was modest, the follow-up period was limited to two weeks after treatment, and the practitioners who delivered the interventions could not be blinded. The authors called for multicenter trials with larger samples and longer follow-up to confirm the findings.

For patients and clinicians, the results add to a growing body of evidence on minimally invasive soft-tissue techniques for disc-related pain. The authors noted that needle-knife therapy is already widely used in China for musculoskeletal conditions, and that the trial provides some of the most rigorous clinical evidence to date on its use for lumbar disc herniation. They suggested that the technique may offer a useful intermediate option for patients who do not achieve adequate relief with conservative therapies but wish to avoid more invasive procedures.

The study was conducted in accordance with the Declaration of Helsinki and approved by the institutional ethics committee. The trial protocol was registered before enrollment, and the authors reported no conflicts of interest. The full statistical analysis plan, including the mixed-effects models and the multiple-comparison correction, is available in the published article.

Subject of Research: Needle-knife lumbosacral therapy for lumbar disc herniation: randomized controlled trial evidence

Article Title: Needle-knife lumbosacral therapy for lumbar disc herniation: a single-center, outcome assessor-blinded randomized controlled trial

Article References: Zhang, Y., Li, R., Zhang, X., Wang, Z., Zhang, Z., Xu, H., & Li, X. (2026). Needle-knife lumbosacral therapy for lumbar disc herniation: a single-center, outcome assessor-blinded randomized controlled trial. Frontiers in Neurology, 17, Article 1898714. https://doi.org/10.3389/fneur.2026.1898714

Image Credits: AI Generated

DOI: 10.3389/fneur.2026.1898714

Keywords: needle-knife therapy, lumbar disc herniation, acupuncture, randomized controlled trial, minimally invasive, pain management, inflammation, neurology, Needle-knife, lumbosacral, therapy, lumbar