Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea.
Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea.
Acupunct Med. 2019 Oct;37(5):268-276. doi: 10.1136/acupmed-2018-011724. Epub 2019 Aug 20.
Surgical treatment of neck pain often entails high costs and adverse events. The present cohort study investigated whether utilisation of acupuncture in neck pain patients is associated with a reduced rate of cervical surgery.
The Korean National Health Insurance Service National Sample Cohort (NHIS-NSC) database was retrospectively analysed to identify the 2 year incidence of cervical surgery in Korean patients suffering neck pain from 2004 to 2010. The incidence was calculated and compared between patients receiving and not receiving acupuncture treatment using Cox proportional hazards models. Cumulative survival rates were compared using Kaplan-Meier survival analysis.
The acupuncture and control groups included 50 171 and 128 556 neck pain patients, respectively. A total of 50 161 patients were selected in each group following propensity score matching with regard to sex, age, income and Charlson comorbidity index. The hazard ratio (HR) for surgery within 2 years was significantly lower in the acupuncture group compared with the control group (HR 0.397, 95% CI 0.299 to 0.527). In addition, subgroup analyses according to gender, age and income revealed consistent results for both men (HR 0.337, 95% CI 0.234 to 0.485) and women (HR 0.529, 95% CI 0.334 to 0.836); the results were consistently observed across all age and income strata. Sensitivity analysis with varying numbers of acupuncture treatments and treatment course duration also consistently indicated lower HRs for surgery within 2 years in the acupuncture group compared with the control group.
A significantly lower HR for cervical surgery was observed in neck pain patients following acupuncture treatment. Acupuncture treatment may therefore be an effective method for managing neck pain, and has the potential to mitigate unnecessary surgery. These findings need to be confirmed by prospective studies.
颈部疼痛的手术治疗通常费用高昂且易发生不良事件。本队列研究旨在探讨颈部疼痛患者接受针灸治疗是否与降低颈椎手术率相关。
回顾性分析了 2004 年至 2010 年韩国国民健康保险服务国家样本队列（NHIS-NSC）数据库，以确定患有颈部疼痛的韩国患者在 2 年内行颈椎手术的发生率。使用 Cox 比例风险模型计算并比较接受和未接受针灸治疗的患者的发生率。使用 Kaplan-Meier 生存分析比较累积生存率。
针灸组和对照组分别纳入了 50171 例和 128556 例颈部疼痛患者。在性别、年龄、收入和 Charlson 合并症指数方面进行倾向评分匹配后，每组各选择了 50161 例患者。与对照组相比，针灸组 2 年内手术的风险比（HR）显著降低（HR 0.397，95%CI 0.299 至 0.527）。此外，根据性别、年龄和收入进行的亚组分析显示，男性（HR 0.337，95%CI 0.234 至 0.485）和女性（HR 0.529，95%CI 0.334 至 0.836）的结果均一致；在所有年龄和收入阶层均观察到一致的结果。使用不同数量的针灸治疗和治疗疗程的敏感性分析也一致表明，针灸组 2 年内手术的 HR 低于对照组。
颈部疼痛患者接受针灸治疗后，颈椎手术的 HR 显著降低。因此，针灸治疗可能是一种有效的颈部疼痛管理方法，并有潜力减少不必要的手术。这些发现需要前瞻性研究来证实。
