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Background The immediate therapeutic impact of thoracic spine manipulation (TSM) on pain levels, cervical mobility, and functional impairment in patients with neck pain has not been conclusively established. Objective This study aimed to assess the short-term outcomes of TSM by contrasting it with sham interventions or alternative treatment approaches for neck pain management. Methods A comprehensive literature review was performed across multiple databases including PubMed, Embase, Web of Science, PEDro, and Cochrane Library, with searches current through January 30, 2023. The analysis focused on randomized controlled trials (RCTs) examining the acute effects of interventions on neck pain patients. Two researchers independently extracted relevant data from selected studies. The primary outcome measure was the difference in clinical measurements taken before and after intervention. Statistical analyses were performed using Review Manager 5.40 software, with the choice of fixed-effect or random-effects model guided by I 2 values. Results The study incorporated 17 randomized controlled trials involving 1,100 participants. The meta-analytical results demonstrate that thoracic spine manipulation (TSM) produces notable improvements in pain reduction (standardized mean difference [SMD] = −0.53; 95% confidence interval: −0.84 to −0.22). Significant enhancements were also observed in cervical range of motion across multiple dimensions: forward bending (SMD = 4.27; 95% CI: 2.14–6.40), extension (SMD = 2.33; 95% CI: 0.17–4.49), left side bending (SMD = 2.29; 95% CI: 0.47–4.10), right side bending (SMD = 2.94; 95% CI: 1.09–4.78), left rotation (SMD = 3.15; 95% CI: 0.82–5.47), and right rotation (SMD = 2.47; 95% CI: 0.18–4.76). Additionally, functional disability showed marked improvement (SMD = -7.31; 95% CI: −10.01 to −4.61). Conclusion Current evidence, ranging from moderate to strong levels, indicates that TSM yields substantial immediate benefits for individuals experiencing cervical discomfort, including pain relief, improved neck mobility, and reduced functional limitations. The intervention demonstrates excellent safety profiles, making it suitable for widespread clinical application.