Effectiveness of conservative interventions on pain and disability in degenerative cervical spine disease: a systematic review and meta-analysis of randomized controlled trials

Abstract

Degenerative cervical spine disease (DCSD) is a major cause of neck pain and disability worldwide. Although conservative interventions are widely used as first-line management, their comparative effectiveness remains unclear. This systematic review and meta-analysis aimed to evaluate and compare the effectiveness of conservative interventions on pain and disability outcomes in patients with DCSD. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted in accordance with PRISMA 2020. PubMed, Scopus, Web of Science, Embase, and CINAHL were searched for studies published from 2006 to 2026. Eligible studies included adults with degenerative cervical spine disease (DCSD) receiving conservative interventions. Random-effects meta-analyses using standardized mean differences (SMDs) with 95% confidence intervals (CIs) were performed. Primary analyses were stratified by comparator type, with intervention-specific subgroup and moderator analyses conducted as secondary exploratory analyses. Eighteen RCTs involving 2,378 participants were included, with 15 (2098 participants) RCTs contributing to the quantitative synthesis. Across comparator categories, conservative interventions were associated with significant reductions in pain (SMD = − 0.67, 95% CI: −0.97 to − 0.37; I² = 87.20%) and disability (SMD = − 0.60, 95% CI: −0.97 to − 0.24; I² = 91.56%). Acupuncture and exercise-based interventions demonstrated significant reductions in pain and disability, whereas manual therapy showed no significant pooled benefit. Intervention-type moderator analyses demonstrated significant omnibus differences in pain (QM(5) = 12.11, p  = 0.033) and disability (QM(5) = 23.97, p  = 0.0002). However, individual contrasts with acupuncture were not significant for pain, while adjunctive rehabilitation and exercise-based interventions differed significantly from acupuncture for disability. The certainty of evidence was low for both outcomes. Conservative interventions may improve pain and functional disability in DCSD. Although intervention-type moderator analyses indicated variation in treatment effects, these exploratory findings do not establish the superiority of any specific intervention. Substantial heterogeneity, limited comparisons within some intervention categories, and low certainty of evidence warrant cautious interpretation. Further high-quality RCTs with standardized protocols and longer follow-up are needed. PROSPERO CRD420261328638.