Ultrasound-guided brachial plexus hydrodissection combined with acupotomy release for the treatment of cervical spondylotic radiculopathy: a multicenter retrospective study.

INTRODUCTION: The incidence of cervical spondylotic radiculopathy (CSR) remains high. Conventional conservative treatments have limited efficacy in relieving mechanical nerve root compression, while surgery is highly invasive. Both acupotomy release and ultrasound-guided brachial plexus hydrodissection are minimally invasive interventions for CSR. Nevertheless, high-level multicenter evidence-based medical data regarding the safety and efficacy of their combined application are still lacking.

METHODS: This multicenter retrospective study enrolled 264 patients with CSR treated at four traditional Chinese medicine hospitals in China between June 2024 and November 2025. The patients were divided into two groups according to the therapeutic regimen: the ultrasound-guided brachial plexus hydrodissection combined with acupotomy release group (HAG) and the ultrasound-guided acupotomy release group (AG). Patients in the AG underwent ultrasound-guided acupotomy release treatment, the target sites for acupotomy release included the C2/3, C4/5, and C6/7 zygapophyseal joints, the C2 spinous process, and the superior medial angles of the bilateral scapulae. Patients in the HAG additionally received ultrasound-guided brachial plexus hydrodissection via the scalene space. Neuroelectrophysiological indicators (F-wave occurrence rate and conduction velocity of the median, ulnar, and radial nerves) were assessed before treatment and at 8 weeks after treatment. he Neck Disability Index (NDI), 36-Item Short Form Health Survey (SF-36), Visual Analogue Scale (VAS), and Numeric Rating Scale (NRS) for the brachial plexus traction test were used to evaluate clinical efficacy at baseline and at 4, 8, and 16 weeks after treatment. Adverse events during treatment were simultaneously recorded.

RESULTS: A total of 212 patients with CSR received treatment in this study. During the follow-up period, 3 patients in the HAG were excluded due to self-administered medication and another 3 were excluded due to loss to follow-up; correspondingly, 5 patients in the AG were excluded due to self-administered medication and 2 were excluded due to loss to follow-up. Consequently, 199 patients with CSR were finally enrolled in this study, including 90 cases in the HAG and 109 cases in the AG. At 8 weeks after treatment, the F-wave occurrence rate and conduction velocity of the median, ulnar, and radial nerves were significantly higher in the HAG than in the AG (p < 0.05). The NDI, VAS, and NRS scores for the brachial plexus traction test in the HAG were markedly lower than those in the AG at all postoperative time points (p < 0.05), whereas the SF-36 score was notably higher (p < 0.05). Both groups of patients experienced transient postsurgical soreness and localized bruising after treatment, no major adverse events, including nerve injury or infection, were observed.

CONCLUSION: Ultrasound-guided brachial plexus hydrodissection combined with acupotomy release is safe and effective in the treatment of CSR. Compared with acupotomy release alone, the combined therapy was associated with greater improvements in neurophysiological parameters, pain severity, upper-limb symptoms, cervical function, and quality of life, thus providing an optimized minimally invasive strategy for the clinical management of CSR.