Background: Neck pain is common. Joint, neural and muscle source of neck pain is common. Hydrodissection is a minimally invasive technique involving injection of fluid to separate fascial layers and release entrapped nerves and tendons. Its use in cervical erector spinae hydrodissection in combination with cervical facet joint injection has not been reported. Methods: Case Presentation: We present the case of a 55-year-old male with refractory neck pain. Despite extensive conservative therapies, including analgesics and physical therapy, he continued to experience neck pain. Intervention: The patient underwent ultrasound-guided cervical facet joint injection and cervical erector spinae hydrodissection as a targeted approach to address joint pain, perineural inflammation and nerve entrapment. Triamcinolone 40mgs and 0.25% Levobupivacaine (8 mls) was used for cervical facet joint injection. A 5% dextrose solution (10 mls) was used to free neural and muscle from scar tissue and adhesions with a cervical erector spinae ultrasound guided hydrodissection on the same side as cervical facet joint injection. The procedure was performed in a theatre setting. Results: Following the hydrodissection procedure, the patient experienced improvement in pain (NRS 6/10 to 2/10) with sustained improvement at two months follow-up. Functional outcomes, including range of motion and daily activities improved. Analgesic requirement reduced. No complications were reported. Conclusions: This case supports the potential role cervical erector spinae hydrodissection as a safe, minimally invasive treatment option in combination with cervical facet joint injection for neck pain. Hydrodissection offers an alternative to more invasive interventions and warrants further investigation in the management of neck pain.
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