Tianxiao Feng,1,2,* Xu Wang,1,2,* Hanmei Bu,1,2 Kai Sun,2,3 Xiaokuan Qin,1,2 Rong Xie,1,2 Liguo Zhu,2,3 Xu Wei1,2 

1Academic Development Office, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, 100102, People’s Republic of China; 2Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, 100102, People’s Republic of China; 3Department of Spine II, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, 100102, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Liguo Zhu; Xu Wei, Email tcmspine@163.com; weixu.007@163.com

Background: Cervical radiculopathy (CR) is a common musculoskeletal disorder worldwide. Cervical rotation-traction manipulation (CRTM) is one of the representative technique in traditional Chinese orthopedics.
Objective: This systematic review and meta-analysis aims to evaluate the effectiveness and safety of CRTM in treating CR.
Methods: A comprehensive literature search was conducted through eight databases to identify the relevant randomized controlled trials (RCTs) from inception to December 2023. The primary outcome was the Visual Analogue Scale (VAS). The secondary outcomes included Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA), Cervical Range of Motion, cervical curvature, and adverse reactions and events. Two researchers independently screened literature, extracted data, and assessed the risk of bias in included studies. Meta-analysis was performed using RevMan 5.4 and Stata 15.0 software, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system was used to assess the quality of the evidence.
Results: A total of 9 RCTs involving 904 patients were included. The results indicated that CRTM significantly reduced VAS scores compared to control groups with low-quality evidence [n=534, WMD=− 1.27, 95% CI (− 1.66, − 0.87), p< 0.00001, I²=59%]. Subgroup analysis showed that differences in control group categories, sample sizes, and intervention durations may contribute to the observed heterogeneity. Besides, CRTM significantly improved cervical range of motion of lateral flexion and rotation with very low-quality evidence. However, no statistically significant differences were observed in NDI scores, JOA scores, or cervical curvature between CRTM and control groups. No adverse reactions and events related to CRTM were reported in included studies, demonstrating its high safety.
Conclusion: Cervical rotation-traction manipulation appears to be an effective and safe option for managing cervical radiculopathy, significantly improving pain and cervical mobility. However, further high-quality randomized controlled trials and methodological studies should be conducted to reinforce the evidence base for its clinical practice.

Keywords: cervical rotation-traction manipulation, cervical radiculopathy, randomized control trial, pain, cervical range of motion, systematic review, meta-analysis