Ultrasound guided needle knife therapy (US-NKT) is a minimally invasive treatment for patients with spinal pain disorders. A systematic review and meta-analysis of 23 randomized controlled trials with a total of 2,107 patients showed that US-NKT significantly reduced pain at one week and one month compared to control groups, while physical function improved at all time points, with the strongest effect at one week. US-NKT has shown better results than recommended therapies and conventional methods of needle therapy in the first weeks and months of treatment. Adverse events were reported in 43.5% of the studies, with the US-NKT groups experiencing a lower number of complications (4.6%) compared to the control groups (13.8%). However, the lasting benefits of treatment after three months were not statistically significant. The study concluded that US-NKT shows superior efficacy in reducing pain and improving physical function with a favorable safety profile.