Objective：To observe the incidence and types of adverse events after lifting and thrusting treatment with different needles for cervical spondylotic radiculopathy（CSR），and to evaluate the safety of lifting and thrusting manipulation with different needles，especially small needle knife，in the treatment of CSR. Methods：A total of 120 CSR patients were randomly divided into acupotomy group（n=60） and acupuncture group（n=60）. The incidence and severity of adverse events，particularly pain，were assessed after a single lifting and thrusting manipulation with two needles of the same diameter. Results：Forty-two patients of the acupotomy group experienced pain after treatment，while only 4 of the acupuncture group experienced this symptom，with a significant difference in the number of cases between the two groups（P=0.000）. Generalized fatigue was seen in 7 patients in the acupotomy group and 1 patient in the acupuncture group，with a significant difference in the number of cases between the two groups（P=0.028）. Pain and fatigue all disappeared within 3 days. After acupotomy，the common local adverse reaction was pain and sore and swelling，usually next to the cervical spinous process or at the transverse process or tubercles，and the common systemic adverse reaction was fatigue；headache and heartburn were seen in some cases. Conclusion：In the lifting and thrusting treatment of CSR，acupotomy is more likely to cause adverse events than acupuncture，but it is generally safe. Treatment guidelines for acupotomy are needed to avoid medical disputes.