BACKGROUND: Spondylosis (CS) is a prevalent condition that significantly impacts quality of life and overall health. Fu's subcutaneous needling, a novel acupuncture technique, has been widely used to treat CS. This study employs a meta-analysis to comprehensively evaluate the efficacy of Fu's subcutaneous needling in treating CS. METHODS: We searched PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science Periodical Database (CSPD), Chinese Citation Database (CCD), and Chinese biomedical literature service system (CBM) databases for clinical trials on Fu's subcutaneous needling for CS, from inception to March 1, 2025. The quality of the included studies was assessed using the Cochrane Handbook for Systematic Reviews, and meta-analysis was performed using Stata 16.0. RESULTS: A total of 46 studies involving 3767 cases were included. The results showed that the Fu's subcutaneous needling group had a higher effective rate than the control group (RR 1.17, 95% CI 1.14 to 1.20, p < 0.05). The Fu's subcutaneous needling group also had lower Visual Analog Scale (VAS) scores (WMD -1.55, 95% CI -1.98 to -1.12, p < 0.05), lower Northwick Park Neck Pain Questionnaire (NPQ) scores (WMD -2.65, 95% CI -5.27 to -0.03, p < 0.05), and lower Neck Disability Index (NDI) scores (WMD -3.40, 95% CI -6.59 to -0.21, p < 0.05) compared to the control group. The Fu's subcutaneous needling group also demonstrated higher safety (RR 0.32, 95% CI 0.13 to 0.75, p < 0.05). Subgroup analysis indicated that Fu's subcutaneous needling was effective across various subtypes of CS and showed significant advantages over other treatment modalities. The Efficacy of Fu's subcutaneous needling improved with longer treatment durations. CONCLUSION: Fu's subcutaneous needling is effective and safe for treating CS. Due to the limited number of included studies, further research is needed to confirm these findings.

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