The Efficacy and Safety of Ultrasound-Guided Nerve Block in the Treatment of Cervical Spondylotic Radiculopathy: A Systematic Review and Meta-Analysis.

Abstract

<h4>Purpose</h4>This meta-analysis systematically compares the clinical efficacy and safety of ultrasound-guided versus non-ultrasound-guided (ie, x-ray fluoroscopy, CT imaging, or anatomical landmark-guided) nerve blocks for cervical spondylotic radiculopathy (CSR).<h4>Patients and methods</h4>Randomized controlled trials (RCTs) comparing ultrasound-guided with conventionally guided nerve blocks for CSR were searched in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Chongqing VIP Chinese Science and Technology Periodical Database (VIP) and Wanfang databases from inception to July 1, 2025. Literature screening, data extraction, and risk of bias assessment were performed independently by two reviewers using the Cochrane tool. Meta-analysis was conducted with RevMan 5.4 and Stata 19.0. Primary outcomes included overall response rate and Visual Analog Scale (VAS) scores; secondary outcomes comprised first-attempt success rate, Neck Disability Index (NDI), 36-Item Short Form Health Survey (SF-36), and complication incidence.<h4>Results</h4>Thirteen RCTs involving 1072 patients were included. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) evidence quality was moderate for overall response rate and low for other outcomes. Compared with conventional guidance, ultrasound-guided nerve blocks resulted in a significantly higher overall response rate (risk ratio (RR) = 1.10, 95% confidence interval (CI): 1.01-1.20, <i>p</i> = 0.030), greater reduction in VAS (MD = -0.72, 95% CI: -1.15 to -0.29, <i>p</i> < 0.001), improved NDI (mean difference (MD) = -1.03, 95% CI: -1.95 to -0.11, <i>p</i> = 0.030), and higher first-attempt success rate (RR = 1.25, 95% CI: 1.12-1.39, <i>p</i> < 0.001). Complication rates were lower but not statistically significant (RR = 0.53, 95% CI: 0.19-1.47, <i>p</i> = 0.230).<h4>Conclusion</h4>This meta-analysis demonstrates that ultrasound-guided nerve blockade is an efficacious and safe intervention for cervical spondylotic radiculopathy, offering advantages over conventional techniques. However, the current evidence is limited by the number and methodological quality of included studies. Future high-quality trials should adopt a multimodal assessment strategy, integrating objective physiological measures with patient-reported outcomes, to strengthen the evidence base and guide personalized management.