Clinical Efficacy and Postoperative Nerve Function Recovery of Buyang Huanwu Decoction for Spinal Cord Injury: A Meta-Analysis

This meta-analysis evaluated whether adding Buyang Huanwu Decoction (BYHWD) to standard surgery improves spinal-cord nerve recovery after traumatic spinal-cord injury (SCI). Following PRISMA and PROSPERO protocol CRD42024612859, we systematically searched PubMed, Cochrane, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang and VIP to January 2025 for randomized controlled trials (RCTs) comparing surgery plus usual care with the same regimen plus BYHWD. Data were pooled with RevMan 5.3. Nine Chinese RCTs (614 patients, 306 BYHWD, 308 control) were included. Relative to controls, BYHWD significantly raised post-operative American Spinal Injury Association(ASIA) sensory score (MD 7.51; 95% CI 5.08–9.93; P <0.01), ASIA motor score (MD 7.65; 5.81–9.49; P <0.01), somatosensory evoked potential amplitude (MD 0.37 µV; 0.18–0.55; P <0.01), motor evoked potential amplitude (MD 0.43 µV; 0.19–0.68; P <0.01) and the proportion of patients achieving ≥1 ASIA grade improvement (RR 1.23; 1.09–1.38; P <0.01). Heterogeneity was low for most outcomes. No serious herb-related adverse events were reported. Adjunctive BYHWD appears to accelerate short-term neurological recovery after surgical decompression for SCI. However, all trials were Chinese, most lacked allocation concealment or blinding, follow-up was brief and outcome sets varied. Large-scale, rigorously blinded, multicentre RCTs with long-term functional endpoints are needed before routine clinical adoption.