Dear editor
Upon a thorough review of the manuscript titled “The Efficacy and Safety of Ultrasound-Guided Nerve Block in the Treatment of Cervical Spondylotic Radiculopathy: A Systematic Review and Meta-Analysis”, we identified several critical inconsistencies and technical errors that require clarification and correction:1
Data Inconsistencies & Logical Contradictions
The study concludes that Ultrasound-Guided (USG) nerve blocks are superior to the control. However, the results for the Physical Component Summary (PCS) and Mental Component Summary (MCS) explicitly state that the control group showed significantly “greater improvement” (p = 0.002 for PCS). This contradicts the overall conclusion and requires reconciliation in our opinion. Also, the results section reports a total of 1072 patients across 13 studies. However, the manual summation of the sample sizes (Treatment vs Control) and also the number of dropouts when totalled do not add up. The number of dropouts mentioned within the table as mentioned is three, however in the note section it is mentioned that five more patients were excluded due to no improvement or exacerbation of pain following the first injection. Another thing to note is that in the study by Wang 2020, the male and female number of participants is not mentioned.2 Hence, details provided in Table 1 result in a different total. We feel that verification of the definitive N for the meta-analysis is required.
Methodological Transparency
The abstract states that the GRADE evidence quality was moderate for the overall response rate and low for other outcomes. However, later in the text, the authors state they used the GRADE approach but do not provide the specific breakdown for each outcome to justify why some were “low” while others were “moderate”. The specific reasons for downgrading evidence (eg., risk of bias, inconsistency, or imprecision) for each primary outcome are not sufficiently detailed in the body of the paper and need to be explained.
Table & Figure Discrepancies
In the “Outcome Indicators” column of Table 1, indicator “g” is applied to the Zou 2021 and Wu 2018 study but is not defined in the table notes.2,3 Also, the text references Figures 3 through 7 are missing. These figures (specifically the forest plots and funnel plots) appear to be missing or are not clearly labelled within the supplementary data sections. For example, when referred to Figure 7, the text claims that the control group showed greater improvement, however, the forest plot clearly demonstrates that the ultrasound-guided intervention group outperformed the control. Both individual studies (Kose 2024 and Liu 2020) and the pooled mean difference (MD = 3.50, 95% CI: 1.26 to 5.75) fall to the right of the zero line, which is explicitly labelled on the x-axis as “Favours (Intervention)”. Additionally, the text contains a minor typo where “PCS” is incorrectly written as “PSC” in the first sentence. To be accurate, the paragraph should state that the meta-analysis found a statistically significant improvement (p = 0.002) in Physical Component Summary scores specifically favouring the ultrasound-guided nerve block group. Lastly, a major inconsistency has been noted between the interpretation in the text and the data presented in the forest plot. The meta-analysis reports a pooled mean difference (MD) of 2.22 (95% CI: 0.79–3.64), which indicates that the effect favours the intervention group because the value is positive. However, the manuscript states that patients in the control group demonstrated greater improvement in Mental Component Summary (MCS) scores compared to those receiving the ultrasound-guided intervention. This interpretation contradicts the statistical result shown in the forest plot. Additionally, the direction labels in the forest plot appear to be reversed, as the right side of the plot is labelled as “Favours control”, whereas the pooled estimate lies on the other side despite the positive MD, which should indicate a benefit for the intervention group. This discrepancy between the statistical output, figure labelling, and textual interpretation requires clarification or correction to avoid misinterpretation of the study findings.
Typographical & Formatting Errors
Several errors are present throughout the paper, such as “Visual Analgue Scale”, which should be corrected to “Analogue” or “Analog”.
Disclosure
The authors report no conflicts of interest in this communication.
References
- 1.Deng M, Wu D, Tang N, Kuang J. The efficacy and safety of ultrasound-guided nerve block in the treatment of cervical spondylotic radiculopathy: a systematic review and meta-analysis. Journal of Pain Research. 2026;19:573563. doi: 10.2147/JPR.S573563 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Wu D, Huang YS, Su DW. Effect of cervical nerve root block on cervical spondylosis under ultrasound guidance. J Clin Psychosom Dis. 2018;24(4):154–2. doi: 10.3969/j.issn.1672-187X.2018.04.047 [DOI] [Google Scholar]
- 3.Zou C, He YW, Long H, et al. A comparative study of clinical efficacy between ultrasound and digital subtraction angiography-guided cervical spinal nerve root block. Chin J Pain Med. 2021;27(9):701–704. doi: 10.3969/j.issn.1006-9852.2021.09.012 [DOI] [Google Scholar]