Efficacy and safety of pulsed radiofrequency combined with nerve block for cervical radiculopathy: a systematic review and meta-analysis

Background Cervical radiculopathy is a common cause of neck–shoulder–arm pain and functional impairment. Although nerve block provides rapid analgesia, its durability may be limited. This systematic review and meta-analysis evaluated whether pulsed radiofrequency combined with nerve block offers superior efficacy and comparable safety to nerve block alone. Methods Eight databases were searched from inception to April 10, 2026. Randomized controlled trials comparing pulsed radiofrequency plus nerve block with nerve block alone in adults with cervical radiculopathy or cervical nerve root pain were included. Meta-analysis was performed using RevMan 5.4. Risk ratios or mean differences with 95% confidence intervals were calculated. Results Nine randomized controlled trials involving 783 patients were included. Compared with nerve block alone, combined therapy significantly improved the overall clinical response rate (RR = 1.13, 95% CI: 1.05–1.22), reduced pain intensity measured by VAS score (MD = −0.87, 95% CI: −1.27 to −0.47), increased cervical flexion–extension range of motion (MD = 8.56, 95% CI: 1.67–15.44), and improved Yasuhisa Tanaka symptom scores (MD = 2.61, 95% CI: 1.81–3.40). No significant difference was observed in adverse reactions (RR = 0.96, 95% CI: 0.52–1.78). Discussion Pulsed radiofrequency combined with nerve block may provide greater pain relief and better overall clinical response than nerve block alone without increasing short-term adverse reactions. Nevertheless, the evidence for functional improvement remains uncertain. The pooled pain difference was modest, functional outcomes were supported by few studies, and the available evidence does not establish durable benefit beyond the reported follow-up periods. Further high-quality multicenter trials are needed to confirm long-term efficacy, clarify functional benefits, and optimize treatment protocols. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251271276 , Identifier: CRD420251271276.