Effectiveness of high-intensity laser therapy in patients with spinal radiculopathy: a systematic review with meta-analysis.

Spinal radiculopathy (SRD) significantly burdens healthcare systems due to its complexity and resulting disabilities. High-Intensity Laser Therapy (HILT) is a promising treatment for managing SRD pain. The aim of this review is to assess the efficacy of HILT in the management of pain associated with SRD. A literature search across PubMed, Scopus, Web of Science, ScienceDirect, EBSCOhost, PEDro, and Google Scholar up to July 1, 2025, aimed to identify randomized clinical trials (RCTs) comparing HILT with other therapies for SRD. The primary outcome focused on pain intensity using the visual analog scale (VAS), with secondary outcomes including disability with the Neck Disability Index (NDI), Oswestry Disability Index (ODI), and range of movement (ROM). RCT quality was assessed using the Risk of Bias 2 tool (RoB2), and a meta-analysis employed the mean difference (MD) and the standardized mean difference (SMD). Evidence-based recommendations were provided with a GRADE approach. Eighteen studies were included-six on cervical and twelve on lumbar SRD-encompassing a total of 1,095 participants (555 received HILT; 540 were controls). The overall RoB was 38.9%, primarily due to shortcomings in outcome measurement and the randomization process. HILT significantly reduced pain when combined with physical therapy (MD = - 1.4 cm; 95% CI: - 2.1, - 0.7; p < 0.05) and compared to placebo (MD = - 1.8 cm; 95% CI: - 3.1, - 0.6). It also reduced disability, whether applied alone (SMD = 2.3; 95% CI: 0.3, 4.4), with physical therapy (SMD = 2.6; 95% CI: 1.0, 4.1), or with exercise (SMD = 0.9; 95% CI: 0.3, 1.5). For ROM, significant improvement was found only when HILT was combined with physical therapy (SMD = 1.1; 95% CI: 0.6, 1.6; p < 0.01). Although the evidence was considered important, its certainty was rated low to very low. HILT is more effective than placebo in reducing pain and disability in individuals with cervical or lumbar radiculopathy, particularly when combined with physical therapy or therapeutic exercise. Future RCTs should integrate therapeutic exercise and ensure greater methodological rigor, particularly through the standardization of outcome measures.