{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T01:11:45Z","timestamp":1793236305772,"version":"4.5.0"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tuina and acupuncture therapy have been widely applied in patients with cervical spondylotic radiculopathy (CSR). This network meta-analysis (NMA) was carried out to compare the effects of tuina or acupuncture in combination with adjunctive therapy on the physical signs, symptoms, and clinical outcomes of patients with CSR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Relevant studies were searched in PubMed, Web of Science, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Data, and China Biology Medicine (CBM), up to June 15, 2023. Randomized controlled trials (RCTs) comparing tuina, acupuncture, or their combination with conventional Western medical adjunctive therapies were selected. Literature quality was assessed using the ROB2 tool, and statistical analyses were conducted using Stata SE15 and R 4.3.1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>90 studies involving 8,612 participants were included. Compared to acupuncture alone, acupuncture + warm needle acupuncture (RR: 17.97; 95% CrI [1.98, 563.78]), acupuncture + cupping (RR: 15.84; 95% CrI [1.48, 538.41]), tuina + auricular acupuncture and conventional therapy (RR: 12.83; 95%CrI [1.31, 170.78]), acupuncture + moxibustion (RR: 8.55; 95% CrI [2.17, 40.28]), and acupuncture + warm needle acupuncture (RR: 8.62; 95% CrI [1.78, 50.25]) significantly improved the clinical response rate, with acupuncture + warm needle acupuncture exhibiting the best effect (SUCRA: 85.9%). Tuina (SUCRA: 75%) ranked highest in improving the cervical function of patients. Electroacupuncture + moxibustion and conventional therapy (SUCRA: 97%) was most effective in relieving pain. None of these therapies effectively improved patient physical signs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Needling + warm needle acupuncture, warm needle acupuncture + auricular acupuncture, and warm needle acupuncture + conventional therapy may better alleviate symptoms in patients with CSR. However, more well-designed multicenter, large-sample RCTs are needed to further analyze the findings from this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42023443945<\/jats:ext-link>\n                      , CRD42023443945.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1612024","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T05:27:12Z","timestamp":1754630832000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Network meta-analysis of tuina or acupuncture in combination with adjunctive therapy for cervical spondylotic radiculopathy"],"prefix":"10.3389","volume":"16","author":[{"given":"Shengxiang","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1002\/pmrj.12089","article-title":"Inciting events associated with cervical radiculopathy","volume":"11","author":"Rainville","year":"2019","journal-title":"PM R"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"E251","DOI":"10.1097\/bsd.0000000000000284","article-title":"Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment","volume":"28","author":"Woods","year":"2015","journal-title":"J Spinal Disord Tech"},{"key":"ref3","first-page":"746","article-title":"Nonoperative Management of Cervical 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\"equal emphasis on muscles and bones\" to explore the effect and mechanism of acupuncture and medicine combined with reconditioning and reconditioning in the treatment of cervical Spondylotic radiculopathy (qi stagnation and blood stasis syndrome)","volume":"27","author":"Zhu","year":"2021","journal-title":"Chin J Surg Integr Tradition West Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"44","DOI":"10.19917\/j.cnki.1005-0779.021139","article-title":"Therapeutic effect of filiform red-hot needling combined with needle-warming moxibustion in treating KOA of wind, cold and dampness bi syndrome and its influence to serum levels of IL-6, COX-2 and MMP-3","volume":"37","author":"Xiong","year":"2021","journal-title":"J Clin Acupunct Moxibust"},{"key":"ref32","first-page":"100","article-title":"The effect and mechanism of acupuncture combined with warm needling in the treatment of cervical spondylosis","volume":"40","author":"Xie","year":"2018","journal-title":"Fujian Med 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edge acupuncture combined with electroacupuncture intervention on the PI3K\/Akt\/JNK1\/2 signaling pathway in the spinal dorsal horn of morphine tolerant rats with bone cancer pain","author":"Zhong","year":"2021"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3969\/j.issn.1007-5615.2011.03.022","article-title":"Low frequency electroacupuncture reduces the expression of p-CREB in the dorsal root ganglia of rats with neuropathic pain","volume":"26","author":"Zhang","year":"2011","journal-title":"J Hebei Tradit Chin Med Pharmacol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"177","DOI":"10.3969\/j.issn.1672-6790.2010.02.025","article-title":"Influence of Jiaji electro-acupuncture on nerve root type cervical spondylosis pain district FOS protein in rat hypothalamus and spinal cord dorsal horn of COX-2 protein content","volume":"13","author":"Gao","year":"2010","journal-title":"Chin J Clin 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meta-analysis of manual treatment for cervical spondylotic radiculopathy","author":"Mo","year":"2022"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"641","DOI":"10.3969\/j.issn.1674-1749.2013.09.001","article-title":"Meta-analysis on nerve-root-type cervical spondylosis treatment by manipulation and cervical traction","volume":"6","author":"Yang","year":"2013","journal-title":"Glob Tradition Chin Med"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"622","DOI":"10.11656\/j.issn.1672-1519.2023.05.15","article-title":"Meta analysis of efficacy and safety of pulling manipulation in the treatment of cervical spondylotic radiculopathy and evaluation of GRADE evidence level","volume":"40","author":"Wang","year":"2023","journal-title":"Tianjin J Tradit Chin Med"},{"key":"ref51","first-page":"9","article-title":"A comparative study on the \"click\" sound of two neck rotation techniques","volume":"6","author":"Li","year":"1998","journal-title":"J Tradition Chin Orthoped 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