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Objective: To compare the efficacy of transverse needling versus perpendicular needling at myofascial trigger points in treating cervical spondylosis and determine a needling direction with a better effect on myofascial pain syndromes such as cervical spondylosis. Method: 106 patients with cervical spondylosis were randomly allocated to two groups. The transverse needling group received transverse needling at myofascial trigger points and the perpendicular needling group, perpendicular needling at myofascial trigger points. The symptoms and signs of cervical spondylosis were scored and the VAS score was recorded in the two groups before and after treatment. Result: In each group, the VAS score had a statistically significant pre-/post-treatment difference (P < 0.05) and decreased after treatment. The VAS score was significantly lower in the transverse needling group than in the perpendicular needling group after treatment, but there was no statistically significant difference between either group (P > 0.05). In each group, the cervical spondylotic symptoms and signs score had a statistically significant pre-/post-treatment difference (P < 0.05) and decreased after treatment. The cervical spondylotic symptoms and signs score was significantly lower in the transverse needling group than in the perpendicular needling group after treatment; there was a statistically significant difference between both groups (P < 0.05). The total efficacy rate was 94.0% in the transverse needling group, which was higher than 79.6% in the perpendicular needling group; there was a statistically significant difference between each group (P < 0.05). Conclusion: Both transverse needling and perpendicular needling can remove myofascial trigger points and treat cervical spondylosis, but transverse needling at myofascial trigger points is superior to perpendicular needling at myofascial trigger points. [ABSTRACT FROM AUTHOR]