Abstract
BACKGROUND: Lumbar disc herniation (LDH) is a leading cause of chronic low back pain, affecting approximately 1-3% of the general population annually with substantial socioeconomic burden. Acupotomy, a minimally invasive Traditional Chinese Medicine (TCM) technique, has demonstrated promise in musculoskeletal disorders, yet large-scale evidence evaluating its combination with pharmacotherapy remains limited. This study evaluated the efficacy and safety of acupotomy combined with celecoxib and Zhenggu Shenjin capsules versus pharmacotherapy alone in patients with LDH. METHODS: This retrospective cohort study analyzed electronic medical records of 800 LDH patients treated at Shandong Wendeng Orthopedic Hospital between February 2023 and October 2024. Using 1:1 propensity score matching (PSM), patients were allocated to the experimental group (acupotomy plus celecoxib 200 mg twice daily and Zhenggu Shenjin capsules 0.99 g three times daily for 4 weeks, n=400) or the control group (celecoxib 200 mg twice daily and Zhenggu Shenjin capsules 0.99 g three times daily without acupotomy, n=400). Primary outcomes included Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) changes at 3 months post-treatment. Secondary outcomes encompassed overall efficacy rates and adverse events (AEs). RESULTS: Following PSM, baseline characteristics were well-balanced (all standardized mean differences <0.10). The experimental group demonstrated significantly greater VAS reduction (4.12±1.28 vs 2.68±1.15, P<0.001) and ODI improvement (22.85±8.47% vs 13.76±7.21%, P<0.001) compared to controls. Overall efficacy rate was significantly higher (78.50% vs 58.75%, P<0.001), while adverse event incidence was lower (4.25% vs 11.50%, P<0.001). Subgroup analyses showed consistent benefits across all strata, with younger patients (<50 years; P-interaction=0.042) and those with shorter symptom duration (<6 months; P-interaction=0.008) deriving greatest benefit. CONCLUSION: Acupotomy combined with celecoxib and Zhenggu Shenjin capsules demonstrated superior pain relief, functional improvement, and safety profile compared to pharmacotherapy alone for LDH treatment. These findings support the integration of this regimen into clinical guidelines for non-surgical LDH management and warrant prospective validation through multicenter randomized controlled trials.