BACKGROUND: Acupotomy, which involves the addition of a scalpel function to the 
conventional acupuncture treatment, has recently been applied as a conservative 
treatment method for lumbar disc herniation (LDH). This study investigated the 
effectiveness and safety of acupotomy, compared to manual acupuncture, for the 
treatment of patients with LDH.
METHODS: A total of 146 patients diagnosed with LDH were randomly assigned to 
either the acupotomy group or the manual acupuncture group at a 1:1 ratio. 
Participants in both groups received four sessions of each intervention over 2 
weeks. Outcome assessments based on the visual analog scale (VAS), Roland Morris 
Disability Questionnaire (RMDQ), Modified-Modified Schober Test (MMST), EuroQol 
Five Dimensions (EQ-5D), clinically important difference (CID), and patient 
global impression of change (PGIC) were conducted at baseline and at 2, 4, and 6 
weeks post-randomization.
RESULTS: The acupotomy group showed significant improvement in VAS and MMST at 
2, 4, and 6 weeks than did the manual acupuncture group. RMDQ was significantly 
different between the two groups at 2 and 6 weeks. In EQ-5D, there was no 
significant difference between the two groups. The proportion of patients with 
≥15 mm decrease on the VAS (minimal CID) was significantly higher in the 
acupotomy group at weeks 2 and 4. Better improvement in the PGIC at week 4 was 
also observed in the acupotomy group. Post-intervention muscle pain was 
reported, but there was no serious adverse event related to interventions.
CONCLUSION: In this study, four sessions of acupotomy treatment were found to be 
effective in improving the pain intensity and range of motion of the lumbar 
region in patients with LDH. Despite post-treatment muscle pain, acupotomy 
treatment can be considered a preferred treatment method over manual 
acupuncture.
TRIAL REGISTRATION: This trial has been registered 24 April 2018 in Clinical 
Research Information Service of South Korea (CRIS-KCT0002824).