Abstract： Objective： To observe the efficacy of Shufeng Zhitong Decoction combined with small acupotomy in the treatment of senile cervical spondylotic radiculopathy （CSR）. Methods： A total of 112 elderly CSR patients admitted to Luhe Central Hospital from March 2023 to March 2024 were selected and divided into the control group and the study group using the random number table method，with 56 cases in each group. The control group received small acupotomy therapy，while the study group received Shufeng Zhitong Decoction combined with small acupotomy therapy. The clinical efficacy and incidence of adverse reactions were compared between the two groups. Comparisons were also made regarding changes in traditional Chinese medicine syndrome scores，vertebral artery hemodynamics [systolic peak velocity（ Vs），end-diastolic peak velocity（ Vd）]，pain degree [Visual Analogue Scale（ VAS）]，cervical function [Neck Disability Index （NDI）]， neck muscle strength， and serum inflammatory factor levels [C-reactive protein （CRP）， tumor necrosis factor- α （TNF- α）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）] before and after treatment. Results：The total clinical effective rate was 96.43% （54/56） in the study group and 82.14% （46/56） in the control group，with a statistically significant difference between the two groups （P＜0.05）. After treatment，traditional Chinese medicine syndrome scores for dizziness， headache， limb weakness and paralysis， and limb numbness decreased in both groups compared to before treatment （P＜0.05），and the scores for these four items in the study group were lower than those in the control group （P＜0.05）. After treatment，vertebral artery Vs and Vd values increased in both groups compared to before treatment （P＜0.05）， while VAS and NDI scores decreased （P＜0.05）. The study group showed higher vertebral artery Vs and Vd values than the control group （P＜0.05），and lower VAS and NDI scores （P＜0.05）. After treatment， muscle strength for right lateral flexion， left lateral flexion， extension， and flexion of the posterior neck improved in both groups compared to before treatment （P＜0.05），and the study group's muscle strength for these movements was greater than that of the control group （P＜0.05）. After treatment， serum levels of CRP， TNF-α， IL-1β， and IL-6 decreased in both groups compared to before treatment （P＜0.05）， and serum levels of CRP， TNF-α，IL-1β，and IL-6 in the study group were lower than those in the control group （P＜0.05）. The incidence of adverse reactions was 5.36% （3/56） in the study group and 1.79% （1/56） in the control group， with no statistically significant difference between the two groups （P＞0.05）. Conclusion：Shufeng Zhitong Decoction combined with small acupotomy is effective in the treatment of elderly CSR. It can improve clinical symptoms，increase vertebral artery blood flow，reduce pain，improve cervical function and neck muscle strength，inhibit inflammatory responses，and exhibits high safety.