Comparison of ultrasound- and fluoroscopy-guided intra-articular corticosteroid injections for hip osteoarthritis.

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Hallux rigidus, a degenerative condition of the first metatarsophalangeal joint, causes joint stiffness and pain. Although non-surgical treatments such as orthotics, physical therapy, platelet-rich plasma, and corticosteroid injections are initially employed, they are effective in only 55% of patients. For those unresponsive to conservative management, cheilectomy is a common surgical intervention. Various approaches include Open Cheilectomy, Minimally Invasive Dorsal Cheilectomy (MIDC), and MIDC with subsequent first-MTP arthroscopy (MIDC-scope). Despite the prevalence of cheilectomy for treating hallux rigidus, the impact of different surgical approaches on parameters of postoperative pain, range of motion (ROM), and patient-reported outcomes (PROMS) remains underexplored. This study evaluated postoperative outcomes to determine whether the type of cheilectomy significantly impacts these key parameters, providing insights into optimizing surgical strategies for hallux rigidus management. Methods: A retrospective review was performed on 31 patients (23 female, 8 males; 13 lefts, 18 right feet) who underwent cheilectomy performed by a single surgeon at tertiary orthopaedic centers in Boston, MA between December 2019 and July 2024. Among them, 8 patients underwent an open cheilectomy, 10 underwent MIDC-scope cheilectomy, and 13 underwent MIDC cheilectomy. Pre- and postoperative measures include ROM (active AROM and passive PROM), Visual Analog Scale (VAS) pain scores, PROMS (Pain Intensity (PI), Pain Interference (PIF), Physical Function (PF), Depression Score, Mental Score), and complications including extensor hallucis longus (EHL) tendon lacerations. Welch’s ANOVA and Welch’s t-tests were utilized to compare pre- and postoperative outcomes due to a sizeable proportion of independently missing data, which precluded the use of paired t-tests. Covariance correlations between patient demographics, preoperative measures, and postoperative findings were also analyzed. Results are presented as mean values with significance set at p < 0.05. Results: VAS pain scores decreased significantly postoperatively in all groups (MIDC: 3.85, MIDC-scope: 5.21, Open: 4.12; p < 0.01, Welch's T-Test). While most PROMs showed no significant improvement (p > 0.17), PI pain scores in the MIDC-scope group decreased by 11.37 (p < 0.05, Welch's T-Test). The open group demonstrated lower mean postoperative PI scores compared to MIDC/MIDC-scopegroups (p < 0.025, ANOVA). Notably, older patients showed increased postoperative PI scores (r(31)=0.61, p < 10^-4) and less reduction in VAS scores (r(31)=-0.64, p < 10^-4). Finally, postoperative complications include one EHL tendon laceration (recognized and treated intraoperatively) and two superficial infections in the MIDC-scope group, and six minor wound complications equally distributed amongst the MIDC, MIDC-scope, and Open groups, all in female patients. Conclusion: Minimally invasive surgery (MIS) cheilectomy approaches have been demonstrated to be a safe and effective treatment for hallux rigidus, with significant postoperative improvements in VAS and PI pain scores. MIS meets the improvement in VAS scores seen in Open Cheilectomies and outperforms them in pain intensity scores. Further longitudinal research is necessary to best understand how this technique compares to other available treatment options and to explore cost analyses between approaches. Additionally, future studies should further investigate the minimal pain improvement post-cheilectomy in older patients to determine age-stratified surgical strategies for optimal hallux rigidus management.

We conducted this updated meta-analysis to evaluate the effects of PRP in patients with knee or hip OA. PubMed, Embase, and Web of Science were searched to identify randomized controlled trials (RCTs) that compared the efficacy of PRP with other intra-articular injections. The outcomes of interest included Western Ontario and McMaster (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analog Scale (VAS), Harris Hip Score (HHS), and International Knee Documentation Committee (IKDC). Twenty-four RCTs with 21 at knee OA and three at hip OA were included in this meta-analysis. The PRP injections significantly improved the WOMAC score, VAS score, IKDC score, and HHS score as compared with comparators. The WOMAC pain, stiffness, and physical function scores were also significantly better in the PRP group than in the control group. Most of the evaluated parameters that favored PRP were observed in knee OA but not in hip OA, at short-term (at 1, 2, 3, 6, 12months) but not long-term follow-up (at 18months), in RCTs with low risk of bias. Intra-articular PRP injection provided better effects than other injections for OA patients, especially in knee OA patients, in terms of pain reduction and function improvement at short-term follow-up. Key Points • This updated meta-analysis, based on great sample size and high-quality studies, evaluates the effects of PRP in patients with knee or hip OA. • Intra-articular PRP injection provided better effects than other injections for OA patients. • Most of the evaluated parameters that favored PRP were observed in knee OA at short term (at 1, 2, 3, 6, 12months).

Acupuncture has been widely used for acute low back pain (LBP), yet there remains continued controversy regarding its efficacy. Therefore, we aimed to critically evaluate the evidence for acupuncture as an effective treatment for acute LBP. English and Chinese databases were searched for randomized controlled trials (RCTs) that involved acupuncture for acute LBP published up to May 2020. Data on the outcomes of pain intensity, functional status, and analgesic use were extracted. The meta-analysis was performed using the Cochrane Collaboration's RevMan 5.3, and pooled data were expressed as mean differences (MD) with 95% confidence intervals (CIs). Of the 13 eligible RCTs identified, 11 RCTs (involving 707 patients) provided moderate-quality evidence that acupuncture has a statistically significant association with improvements in VAS (visual analog scale) score [MD: -1.75 (95% CI: -2.39, -1.12)]. Two studies indicated that acupuncture did not influence the RMDQ (Roland-Morris Disability Questionnaire) scores more than the control treatment [MD: -2.34 (95% CI: -5.34, 0.67)]. Three studies suggested that acupuncture influenced the ODI (Oswestry Disability Index) scores more than the control treatment [MD: -12.84 (95% CI: -23.94, -1.74)]. Two studies suggested that acupuncture influenced the number of pills more than the control treatment [MD: -3.19 (95% CI: -3.45, -2.92)]. Acupuncture treatment of acute LBP was associated with modest improvements in the VAS score, ODI score, and the number of pills, but not the RMDQ score. Our findings should be considered with caution due to the low power original studies. High-quality trials are needed to assess further the role of acupuncture in the treatment of acute LBP.

Comparative effectiveness of weekly versus biweekly combined greater and supraorbital nerve blocks in chronic migraine: A retrospective observational cohort study.

Comparing Modified Light Bulb with Multiple Drilling Methods in Treating Non-Traumatic Femoral Head Osteonecrosis: A Cohort Study

ObjectiveThis study aims to evaluate and compare the clinical and radiological results of the multiple drilling (MD) technique with the Modified Light Bulb (MLB) method for treating pre-collapse stage osteonecrosis of the femoral head (ONFH).MethodsThis retrospective cohort study included thirty-eight patients (51 hips) with non-traumatic ONFH treated with either the MD technique (23 hips) or the MLB method (28 hips) from March 2019 to March 2021. Evaluations of the patients were performed using the Visual Analog Scale (VAS), Harris Hip Score (HHS), Hip Dysfunction and Osteoarthritis Outcome Score (HOOS), and Ficat-Arlet classification at the initial, six-month, and twelve-month postoperative intervals.ResultsSignificant improvements in VAS, HHS, and HOOS scores were observed in both groups from baseline to the 12-month follow-up (p < 0.001). At the six-month mark, the MLB group exhibited significantly lower VAS scores (3.82 ± 2.43 vs. 5.30 ± 2.54, p = 0.03) and at twelve months (3.07 ± 2.81 vs. 5.17 ± 3.14, p = 0.01). Additionally, HOOS scores were significantly higher in the MLB group at six months (59.99 ± 18.88 vs. 49.16 ± 17.20, p = 0.03) and twelve months (65.88 ± 19.72 vs. 52.13 ± 23.73, p = 0.04) compared to the MD group. Although the clinical success rate was greater in the MLB group (57.1 % vs. 39.1 %), this difference was not statistically significant (p = 0.20). Preoperative ARCO stage was a significant predictor of clinical outcomes in both groups.ConclusionsBoth MD and MLB techniques are effective for treating non-traumatic ONFH in the pre-collapse stage, with the MLB technique showing superior outcomes in terms of pain relief and functional improvement. Early diagnosis and intervention are crucial for achieving optimal results.

Background: De Quervain tenosynovitis is commonly seen in patients who perform repetitive wrist ulnar deviation with thumb abduction and extension. Previous studies comparing nonsurgical options have contributed to a lack of consensus about ideal management. This study's purpose was to analyze results in prospectively randomized patients treated with either corticosteroid injection (CSI) alone versus CSI with immobilization. Methods: Radial sided wrist pain, first dorsal compartment tenderness, and positive Finkelstein test were used to define De Quervain. Pain score of 4 or higher on a visual analog scale (VAS) was utilized for inclusion. Following exclusion criteria, patients underwent randomization into groups: (1) CSI alone; or (2) CSI with 3 weeks of immobilization. We followed at 3 weeks and 6 months for further evaluation, where resolution of symptoms and improvements in VAS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed to evaluate treatment success. Results: Nine patients with CSI alone and 11 patients with CSI and immobilization were followed. At 6 months in both groups, patients experienced significant improvement in VAS and DASH scores, while 88% of patients with CSI alone and 73% of patients with CSI and immobilization experienced complete resolution of at least 2 out of 3 of their pretreatment symptoms. Between groups, outcomes were comparable except for resolution of radial-sided wrist pain, which was superior in patients with CSI alone (100% vs 64%). Conclusions: Immobilization following injection increases costs, may hinder activities of daily living, and did not contribute to improved patient outcomes in this study. Further prospective studies are warranted.

This study aimed to evaluate the effect of increased body mass index (BMI) on patient-reported outcomes (PROs) and clinically significant outcomes (CSOs) obtained > two years postoperatively following arthroscopic superior capsular reconstruction (ASCR). A retrospective study was conducted on patients who underwent ASCR with a minimum two year follow-up. All patients were divided into normal (BMI < 25.0), overweight (BMI 25-30.0), and obese (BMI ≥ 30) according to preoperative BMI. Patients were assessed using the PROs preoperatively and at six months, one year, and two years postoperatively, including the visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores. The time required to achieve each CSO was analyzed and compared. Multivariate analyses evaluated the predictor variables and time required to achieve CSOs. This study included 63 patients with a mean age of 64.8 ± 8.6 years, including 31 normal BMI, 25 overweight, and seven obese patients. Significant improvements in VAS and ASES scores after ASCR were observed in all three groups. Normal and overweight patients had significant improvements in the Constant score; however, no difference was observed in obese patients. No significant difference was observed in the probability distributions of CSOs between the BMI groups. Similarly, no significant differences were observed in the probability distributions of the CSOs, ASES, and Constant scores at each time point, among the BMI groups. Patients in the normal and overweight groups had significant improvements in the VAS, ASES, and Constant scores after ASCR. Patients in the obese group had a significant improvement in VAS score; however, there is no difference for the ASES and Constant scores in the obese group. However, no differences were observed in all PROMs and the likelihood of achieving CSOs among the different BMI groups.

PurposeIntra-articular injection of hyaluronic acid (HA) has shown promises in reducing pain and improving physical function in knee osteoarthritis (OA). Recently, cell-based therapies using mesenchymal stem cells (MSCs) have emerged as potential treatments. However, few studies have compared the treatment outcomes between MSCs and HA. This study aimed to compare the clinical and radiological outcomes of intra-articular injections of MSCs versus HA in patients with knee OA.MethodsA cohort of 209 patients with knee OA were retrospectively screened for those who underwent intra-articular injections using MSCs or HA. Thirty MSC-treated patients (MSC group) were pair-matched with thirty HA-treated patients (HA group) based on gender and age. Clinical outcomes were evaluated using the visual analog scale (VAS), International Knee Documentation Committee (IKDC) rating system, and Lysholm scoring system. Radiological evaluation was assessed using the Kellgren-Lawrence (K-L) grading system.ResultsMSC treatment yielded consistent significant improvements in VAS, IKDC and Lysholm scores. In the HA group, VAS scores significantly decreased at 1 month, slightly increased at 3 months, and increased significantly from 3 months to 1 year after injection. The IKDC and Lysholm scores improved significantly until 3 months, but gradually worsened thereafter. Significantly greater improvements in VAS (P = 0.041), IKDC (P = 0.014), and Lysholm (P = 0.020) scores were observed in the MSC group compared to those in the HA group at 1-year post-treatment. The K-L grade worsened in a few patients, especially those in the HA group, albeit no significant difference.ConclusionsMSC group showed better VAS, IKDC, and Lysholm scores at 1-year post-treatment, compared to the HA group, although earlier clinical improvements were superior in the HA group for the initial 3 months.Level of EvidenceTherapeutic study, Level III.

The aim of this study was to explore the usefulness of unilateral, combined unilateral (left + right), and bilateral peak nasal inspiratory flow (PNIF) measurements in assessing the results of nasal septal surgery. Nasal obstruction was recorded subjectively and objectively before and 4 months after nasal septoplasty using a visual analogue scale (VAS) and a PNIF meter. Nasal septoplasty (58 patients) and septoplasty with turbinoplasty (68 patients) were performed on 126 patients (85 males; 41 females) with a mean age of 32.8 years. The results showed a significant improvement in VAS scores, as well as unilateral, combined unilateral, and bilateral PNIF values after both septoplasty and septoplasty with turbinoplasty. Septoplasty with turbinoplasty showed better improvement in VAS and PNIF scores than septoplasty alone and this was significant for bilateral PNIF scores. The best unilateral pre- and postoperative correlations between VAS and PNIF measurements were found using the lower of the two unilateral PNIF scores, irrespective of side. In the total material, VAS/PNIF correlations were mostly significant, but weak (all r<0.30). We found VAS and PNIF to be useful instruments in reporting results of surgery. The weak correlations between VAS and PNIF measurements suggest that these subjective and objective instruments may target different aspects of nasal obstruction.

To evaluate the short-term effectiveness of minimally invasive total hip arthroplasty (THA) by direct anterior approach (DAA). Between January and August 2014, THA was performed on 48 patients (60 hips) by DAA (group A), and on 72 patients (92 hips) by posterolateral approach (group B). There was no significant difference in gender, age, etiology, course, and preoperative visual analogue scale (VAS), Harris hip score (HHS), and hip range of motion (ROM) between 2 groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, incision healing, and complications were recorded and compared. The acetabular abduction and anteversion were measured on the X-ray films; prosthesis loosening was observed. The VAS score, HHS score, and hip ROM were used to evaluate the hip function. The operation time and intraoperative blood loss of group A were significantly higher than those of group B, and the hospitalization time was significantly lower than group B ( P<0.05), but no significant difference was found in postoperative drainage between 2 groups ( t=0.71, P=0.46). The patients were followed up 2-2.5 years (mean, 2.2 years) in group A, and 2-2.5 years (mean, 2.1 years) in group B. In group A, 3 cases had lateral femoral cutaneous nerve traction injury and 1 case had swelling and exudate, and primary healing of incision was obtained in the other cases of group A and all cases of group B. No periprosthetic joint infection occurred in the others of groups A and B except 1 case of group A at 2 months after operation, and infection was controlled after debridement, irrigation, and intravenous infusion of Vancomycin for 1 month. The X-ray films showed good position of prosthesis and no obvious radiolucent line or prosthesis loosening. There was no significant differences in acetabular abduction and anteversion between groups A and B at last follow-up ( P>0.05). The VAS score, HHS score, and hip ROM at 3 months and last follow-up were significantly better than preoperative ones in 2 groups ( P<0.05), but no significant difference was found between at 3 months and last follow-up ( P>0.05). The VAS score, HHS score, and hip ROM in group A were significantly better than those in group B at 3 months postoperatively ( P<0.05). At last follow-up, the hip ROM in group A was significantly better than that in group B ( P<0.05), and there was no significant difference in VAS and HHS scores between group A and group B ( P>0.05). The short-term effectiveness of minimally invasive THA by DAA is satisfactory, with the advantage of little trauma, short hospital stay, and rapid postoperative recovery.

Background:Intra-articular corticosteroid injections have been widely used and are considered a mainstay in the nonoperative treatment of symptomatic knee osteoarthritis (OA). However, their increased use can have negative implications, including chondral toxicity and a high risk of infections. As a result, nonsteroidal anti-inflammatory drugs have been considered as an alternative.Purpose:To determine the pain relief and safety of ketorolac versus a corticosteroid to supplement an intra-articular sodium hyaluronate injection for the treatment of symptomatic knee OA.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 84 patients with unilateral symptomatic knee OA receiving 5 weekly injections were enrolled in this retrospective study. Group A (n = 42) received 3 weekly intra-articular corticosteroid injections (0.5% lidocaine, 25 mg of triamcinolone acetonide, and 25 mg of sodium hyaluronate, followed by 2 weekly injections of 0.5% lidocaine and 25 mg of sodium hyaluronate), while group B (n = 42) received 5 weekly ketorolac injections (0.5% lidocaine, 10 mg of ketorolac, and 25 mg of sodium hyaluronate). The following parameters were used to evaluate pain relief and safety: visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and side effects before the injection and at 1, 2, and 5 weeks after treatment commencement as well as 3 months after the last injection.Results:Patients from both groups had a significant improvement in VAS and WOMAC scores from the first injection to final follow-up at 3 months. In the first week, the VAS score was lower in group A (P = .041), but no significant between-group differences were found for either the VAS or the WOMAC score at the other time points. Of the 42 patients in group A, 34 (81.0%) and 25 (59.5%) achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. In group B, 32 (76.2%) and 24 (57.1%) patients achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. At final follow-up, no significant difference was found in the successful treatment rate between the groups (P = .825).Conclusion:The current study demonstrated that intra-articular ketorolac and corticosteroid injections produce the same pain relief and functional improvement.

Background: Full-thickness radial meniscal tears render the meniscus nonfunctional and have historically been treated with partial meniscectomy. As preservative techniques evolve for radial repair, comparisons with other tear patterns are necessary to evaluate repair efficacy and prognosis. Purpose: To assess clinical outcomes and reoperation rates of radial meniscal repair and to compare them to bucket-handle meniscal repair. Study Design: Cohort study; Level of evidence, 3. Methods: Radial and bucket-handle meniscal tears without concurrent root injuries undergoing surgical repair at a single institution between 2007 and 2015 were analyzed, including both all-inside and inside-out suturing techniques. Propensity matching was performed on the basis of age at surgery, sex, meniscus laterality, body mass index (BMI), and concomitant anterior cruciate ligament reconstruction (ACLR) using a comparison pool of 70 bucket-handle repairs. Reoperation-free survival rates and Tegner, visual analog scale (VAS) for pain, and International Knee Documentation Committee (IKDC) scores were analyzed. Results: Twenty-four patients (18 male, 6 female; mean age, 22.8 ± 11.9 years) who underwent repair of a radial meniscal tear were followed for a mean of 3.5 years (range, 2.0-6.3 years). Significant postoperative improvements in VAS scores at rest and with use and IKDC scores were noted postoperatively (P < .001). Five patients (20.8%) required a reoperation. Subsequently, 18 patients with radial tears (mean age, 19.1 ± 9.1 years; 12 male; mean BMI, 27.0 ± 6.2 kg/m2; 3 medial; 11 ACLR) were propensity matched to 18 patients with bucket-handle tears (mean age, 20.8 ± 5.1 years; 13 male; mean BMI, 25.0 ± 3.5 kg/m2; 3 medial; 11 ACLR). The matched radial and bucket-handle groups demonstrated similar (P = .17) reoperation-free survival rates at 2 years (88.9% and 94.4%, respectively) and 5 years (77.8% and 87.7%, respectively). VAS and IKDC scores improved significantly after surgery (P < .001), with no difference noted between the groups (P ≥ .17). Patients with radial and bucket-handle meniscal repairs achieved mean postoperative Tegner scores (6.6 and 6.6, respectively) not significantly different from their preinjury levels (6.9 and 6.7, respectively) (P ≥ .32). Conclusion: Satisfactory clinical outcomes are achievable for radial meniscal tear repair at short-term follow-up. In a robustly matched comparison, radial and bucket-handle meniscal tears demonstrate similar improvements in VAS and IKDC scores, restoration of preoperative Tegner scores, and acceptable reoperation rates. Full-thickness radial meniscal tears should be considered for repair.

Introduction: Osteoarthritis (OA) is the most common degenerative joint disease characterised by the loss of articular cartilage and synovial inflammation. This condition causes stiffness and swelling in the joint, as well as pain, loss of movement and disability. When performed under Ultrasound Guidance (USG), steroid treatments offer several advantages. On the other hand, ozone therapy accelerates anabolic mechanisms, provides vascularisation of cartilage and bone, and slows down the degenerative process. Additionally, it affects inhibitory cytokines, antioxidant enzymes, and neoangiogenesis. Aim: To evaluate and compare the effectiveness of USG intra-articular ozone therapy versus corticosteroid injections in managing hip OA (coxarthrosis) in patients who have not responded to conventional treatments. Materials and Methods: A retrospective comparative study was conducted at Ankara Training and Research Hospital, Ankara, Altındag, Turkey, from August 2021 to August 2022. Patients unresponsive to conventional treatments were divided into two groups: Group A (n=30) received intra-articular steroid (triamcinolone acetonide), and Group B (n=23) received three weekly ozone sessions (200 μg/20 mL), both under USG. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Harris Hip Score (HHS) for functional status, both pre- and post-treatment. Monthly analgesic use was monitored before treatment and at the 1st week, 1st month, 3rd month and 6th month. Statistical analysis were conducted using Unpaired t-tests and Chi-square tests. A p-value &lt;0.05 was considered statistically significant. Results: A total of 53 patients (mean age 63.23±10.50 years) participated in the study. Analgesic needs decreased in both groups, with no significant differences observed in the 1st week, 1st month, 3rd month, and 6th month (p-value=0.139, p-value=0.724, p-value=0.391, p-value=0.546). The most notable improvement occurred one month post-treatment, particularly in low-stage coxarthrosis. Increases in HHS scores and decreases in VAS values for stages 2-3 were statistically significant in both groups (p-value &lt;0.001). Conclusion: The effectiveness of steroid and ozone therapy for coxarthrosis varies by disease stage. Both treatments are more effective in the early stages, while ozone is ineffective and steroids offer limited benefits in advanced stages. Thus, treatment planning should consider the disease stage, and alternative strategies should be explored for advanced cases. Clinicians should prioritise early intervention and seek alternative options for better patient outcomes.

BackgroundChronic mechanical low back pain (CMLBP) is a common cause of disability, and exercise-based interventions are first-line management. Yoga has emerged as a mind-body alternative, but evidence comparing yoga with conventional therapeutic exercise (CTE) remains inconsistent.ObjectiveThis study aims to compare the short-term effects of a structured yoga program versus CTE on pain intensity, analgesic use, and functional disability in adults with CMLBP.MethodsA single-center, parallel-group randomized, comparative study was conducted in a tertiary care center in North India. Sixty participants (ages 25-40 years) with CMLBP were randomized (1:1) to either yoga (25-minute supervised sessions twice weekly + home practice) or CTE (50-minute supervised daily exercise) for six weeks. Primary outcomes were pain intensity (visual analog scale (VAS)) and weekly analgesic consumption. The secondary outcome was functional disability (Oswestry Disability Index (ODI)). Analyses followed the intention-to-treat principle. Between-group comparisons used independent t-tests and analysis of covariance (ANCOVA) (adjusting for baseline). Clinical significance was evaluated using established minimal clinically important difference (MCID) thresholds (VAS ≥ 1.5-2.0; ODI ≥ 10).ResultsAll 60 participants completed the study (adherence: ≥90%). Both groups demonstrated significant within-group improvements in VAS, ODI, and analgesic use (all p < 0.001; large effect sizes d = 2.02-3.82). Between-group analysis favored yoga for all outcomes: VAS reduction showing yoga 4.26 vs. CTE 3.60 (t = 2.78, p = 0.007; d = 0.71, adjusted mean difference = 0.6 points; 95% CI 0.20-1.06); ODI reduction showing yoga 21.7 vs. CTE 17.2 (t = 3.21, p = 0.002; d = 0.82; adjusted mean difference = 4.5, 95% CI 1.73-7.67); and analgesic reduction showing yoga 7.9 vs. CTE 6.8 (t = 2.21, p = 0.031; d = 0.56, adjusted mean difference = 1.0 tablet/week, 95% CI 0.3-2.3), not significant after Bonferroni correction (α = 0.0167). Between-group differences for VAS (≈0.6) and ODI (≈4.5) did not exceed MCID, indicating clinically modest advantages despite statistical significance. No serious adverse events occurred.ConclusionA short-duration, structured yoga program resulted in greater short-term improvement in pain, disability, and analgesic use than a higher-dose CTE regimen, although the clinical superiority was modest. Yoga may represent a time-efficient, low-burden alternative, rather than a definitively superior intervention. Larger, multicenter trials with long-term follow-up and dose-matched protocols are warranted.