Journal of pain research · 2026
Comparison of Acupuncture and Lumbar Traction for Lumbar Disc Herniation and Subsequent Risk of Lumbar Fusion or Discectomy: A Retrospective Cohort Study.
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Tsai SHL, Chen MH, Hsieh HY, Hsu LS, Hsu J, Lee HC, Tsai SA, Huang HE, Lee CY, Chen CH, Huang TJ, Wu MH, Wei JC, Hung YC
Аннотация
BACKGROUND: Lumbar disc herniation (LDH) is commonly treated with conservative therapies, but comparative evidence on acupuncture versus lumbar traction and subsequent surgery is limited. We examined whether acupuncture was associated with lower 5-year risks of discectomy or spinal fusion than traction among adults with LDH.
METHODS: We conducted a retrospective cohort study using deidentified electronic health records from the TriNetX US Collaborative Network from January 1, 2000, to December 31, 2023. Adults aged 20 years or older with LDH who received acupuncture or traction after diagnosis were included. We excluded patients with prior lumbar surgery, lumbar or pelvic fracture, vertebral malignancy, lumbar disc infection or treatment crossover. Propensity score matching was performed 1:1 for demographics, lifestyle factors, comorbidities, health care utilization and body mass index. Primary outcomes were 5-year discectomy and spinal fusion. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
RESULTS: After matching, 3045 patients were included in each group and baseline characteristics were balanced. Discectomy occurred in 77 patients receiving acupuncture and 175 receiving traction (2.5% v. 5.7%; hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.35-0.60; absolute risk reduction [ARR] 3.2%; number needed to treat [NNT] 31). Spinal fusion occurred in 128 patients receiving acupuncture and 188 receiving traction (4.2% v. 6.2%; HR 0.73, 95% CI 0.58-0.91; ARR 2.0%; NNT 51).
INTERPRETATION: Among adults with LDH, receipt of acupuncture was associated with lower observed 5-year risks of subsequent discectomy and spinal fusion compared with lumbar traction. These associations should be interpreted cautiously because residual confounding, including differences in concomitant treatments and unmeasured disease severity, cannot be excluded. Prospective studies are needed to determine whether acupuncture itself influences subsequent surgical utilization.
METHODS: We conducted a retrospective cohort study using deidentified electronic health records from the TriNetX US Collaborative Network from January 1, 2000, to December 31, 2023. Adults aged 20 years or older with LDH who received acupuncture or traction after diagnosis were included. We excluded patients with prior lumbar surgery, lumbar or pelvic fracture, vertebral malignancy, lumbar disc infection or treatment crossover. Propensity score matching was performed 1:1 for demographics, lifestyle factors, comorbidities, health care utilization and body mass index. Primary outcomes were 5-year discectomy and spinal fusion. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
RESULTS: After matching, 3045 patients were included in each group and baseline characteristics were balanced. Discectomy occurred in 77 patients receiving acupuncture and 175 receiving traction (2.5% v. 5.7%; hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.35-0.60; absolute risk reduction [ARR] 3.2%; number needed to treat [NNT] 31). Spinal fusion occurred in 128 patients receiving acupuncture and 188 receiving traction (4.2% v. 6.2%; HR 0.73, 95% CI 0.58-0.91; ARR 2.0%; NNT 51).
INTERPRETATION: Among adults with LDH, receipt of acupuncture was associated with lower observed 5-year risks of subsequent discectomy and spinal fusion compared with lumbar traction. These associations should be interpreted cautiously because residual confounding, including differences in concomitant treatments and unmeasured disease severity, cannot be excluded. Prospective studies are needed to determine whether acupuncture itself influences subsequent surgical utilization.