Background: Chronic low back pain affects 15% - 45% of adults, with facet joint pathology contributing substantially to this burden. Current interventional treatments—including intra-articular corticosteroid injections and medial branch blocks—demonstrate highly variable success rates (13% - 74% for ≥50% pain relief). Hydrodissection, a technique using larger volumes of injectate (5 - 30 mL) to mechanically release entrapped nerves from adhesions, has shown promising results for peripheral nerve entrapments and select spinal applications. However, its application to lumbar facet joint interventions remains unexplored. Objective: To map and characterize the existing evidence base regarding the application of hydrodissection to lumbar facet joint interventions and medial branch blocks, identify the extent, range, and nature of available evidence (or its absence), and establish a research agenda to address identified gaps, following established scoping review methodology (PRISMA-ScR/JBI framework). Methods: A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases from inception through January 2026. Search terms included hydrodissection, lumbar facet joint, medial branch block, and related terminology. Two independent reviewers screened titles, abstracts, and full texts. Reference lists of relevant articles were manually searched. Results: No published studies—randomized controlled trials, observational studies, or case series—specifically applied hydrodissection technique to lumbar facet joint injections or medial branch blocks. While extensive literature exists for standard facet interventions (Levels I - II evidence from multiple systematic reviews and guidelines), and hydrodissection has been successfully applied to related structures (superior cluneal nerve with 80% response rates, caudal epidural space, cervical nerve roots), the translation to facet joint interventions represents a complete evidence gap. Technical challenges include ultrasound visualization accuracy (11% - 13% incorrect needle placement versus fluoroscopy) and volume considerations that may compromise diagnostic specificity. Conclusions: The complete absence of evidence for hydrodissection in lumbar facet joint interventions represents a significant research opportunity. Given the theoretical mechanistic rationale (nervi nervorum release, vasa nervorum restoration), successful applications in anatomically related structures, and limitations of current
References
[1]
Hartvigsen, J., Hancock, M.J., Kongsted, A., Louw, Q., Ferreira, M.L., Genevay, S., et al. (2018) What Low Back Pain Is and Why We Need to Pay Attention. The Lancet, 391, 2356-2367. https://doi.org/10.1016/s0140-6736(18)30480-x
[2]
Dieleman, J.L., Baral, R., Birger, M., Bui, A.L., Bulchis, A., Chapin, A., et al. (2016) US Spending on Personal Health Care and Public Health, 1996-2013. JAMA, 316, 2627-2646. https://doi.org/10.1001/jama.2016.16885
[3]
Manchikanti, L., Singh, V., Falco, F.J.E., Benyamin, R.M. and Hirsch, J.A. (2014) Epidemiology of Low Back Pain in Adults. Neuromodulation: Technology at the Neural Interface, 17, 3-10. https://doi.org/10.1111/ner.12018
[4]
Schwarzer, A.C., Aprill, C.N., Derby, R., Fortin, J., Kine, G. and Bogduk, N. (1995) The Prevalence and Clinical Features of Internal Disc Disruption in Patients with Chronic Low Back Pain. Spine, 20, 1878-1883. https://doi.org/10.1097/00007632-199509000-00007
[5]
Cohen, S.P. and Raja, S.N. (2007) Pathogenesis, Diagnosis, and Treatment of Lumbar Zygapophysial (Facet) Joint Pain. Anesthesiology, 106, 591-614. https://doi.org/10.1097/00000542-200703000-00024
[6]
Lee, J.H. and Lee, S.H. (2025) The Effectiveness of Fluoroscopically Guided Lumbar Facet Steroid Joint Injections: A Systematic Review. North American Spine Society Journal, 21, Article 100482.
[7]
Manchikanti, L., Kaye, A.D., Soin, A., et al. (2020) Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician, 3, S1-S127. https://doi.org/10.36076/ppj.2020/23/s1
[8]
Yoshinaga, T., Koga, T. and Koga, H. (2025) Effectiveness of Ultrasound-Guided Hydrodissection for Atypical Anterior Cutaneous Nerve Entrapment Syndrome Presenting as Lower Back Pain Due to Retrograde Neuropathic Pain. Cureus, 17, e94871. https://doi.org/10.7759/cureus.94871
[9]
Hagiwara, Y., Natsume, Y., Wagatsuma, T., Hasegawa, T. and Yoshida, R. (2024) Low Back Pain Caused by Traction Peripheral Neuropathy Due to Chronic Ankle Instability: Three Clinical Cases. Cureus, 16, e65405. https://doi.org/10.7759/cureus.65405
[10]
Lam, K.H.S., Hung, C., Chiang, Y., Onishi, K., Su, D.C.J., Clark, T.B., et al. (2020) Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms. Journal of Pain Research, 13, 1957-1968. https://doi.org/10.2147/jpr.s247208
[11]
Rha, D.W. and Lee, D.J. (2022) Effectiveness and Safety of Hydrodissection of the Median Nerve with 5% Dextrose for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. Medicine (Baltimore), 101, e31157.
[12]
Evers, S., Thoreson, A.R., Smith, J., Zhao, C., Geske, J.R. and Amadio, P.C. (2018) Ultrasound‐Guided Hydrodissection Decreases Gliding Resistance of the Median Nerve within the Carpal Tunnel. Muscle & Nerve, 57, 25-32. https://doi.org/10.1002/mus.25723
[13]
Asbury, A.K. and Fields, H.L. (1984) Pain Due to Peripheral Nerve Damage. Neurology, 34, 1587-1587. https://doi.org/10.1212/wnl.34.12.1587
[14]
Bennett, G.J. and Xie, Y.-K. (1988) A Peripheral Mononeuropathy in Rat that Produces Disorders of Pain Sensation Like Those Seen in Man. Pain, 33, 87-107. https://doi.org/10.1016/0304-3959(88)90209-6
[15]
Liu, Y.C., Li, Y., Lam, K.H., et al. (2021) Hypertonic Dextrose Prolotherapy Downregulates TRPV1 Expression and Alleviates Chronic Neuropathic Pain via Perineural Injection: An Animal Model and Clinical Study. Journal of Pain Research, 14, 3339-3351.
[16]
Lyftogt, J. (2007) Subcutaneous Prolotherapy Treatment of Refractory Knee, Shoulder, and Lateral Elbow Pain. Australasian Musculoskeletal Medicine, 12, 110-112.
[17]
Lin, C.Y., Lin, Y.J., Lam, K.H., et al. (2022) Effectiveness of Ultrasound-Guided Dextrose Prolotherapy for Superior Cluneal Nerve Entrapment: A Randomized Controlled Trial (NCT04478344). Pain Medicine, 23, 1012-1021.
[18]
Cass, S.P. (2016) Ultrasound-Guided Nerve Hydrodissection: What Is It? A Review of the Literature. Current Sports Medicine Reports, 15, 20-22. https://doi.org/10.1249/jsr.0000000000000226
[19]
Maniquis-Smigel, L., Reeves, K.D., Jeffrey, A.E., et al. (2018) Short and Long Term Analgesic Effects of 5% Dextrose Epidural Injections for Chronic Low Back Pain: A Randomized Controlled Trial. Journal of Prolotherapy, 10, e961-e967.
[20]
Manchikanti, L., Boswell, M.V., Singh, V., Pampati, V., Damron, K.S. and Beyer, C.D. (2004) Prevalence of Facet Joint Pain in Chronic Spinal Pain of Cervical, Thoracic, and Lumbar Regions. BMC Musculoskeletal Disorders, 5, Article No. 15. https://doi.org/10.1186/1471-2474-5-15
[21]
Kennedy, D.J., Engel, A., Kreiner, D.S., Nampiaparampil, D., Duszynski, B. and MacVicar, J. (2015) Fluoroscopically Guided Diagnostic and Therapeutic Intra-Articular Sacroiliac Joint Injections: A Systematic Review. Pain Medicine, 16, 1500-1518. https://doi.org/10.1111/pme.12833
[22]
Ribeiro, L.H., Furtado, R.N.V., Konai, M.S., Andreo, A.B., Rosenfeld, A. and Natour, J. (2013) Effect of Facet Joint Injection versus Systemic Steroids in Low Back Pain: A Randomized Con-Trolled Trial. Spine, 38, 1995-2002. https://doi.org/10.1097/brs.0b013e3182a76df1
[23]
Láinez Ramos-Bossini, A.J., Jiménez Gutiérrez, P.M. and Ruiz Santiago, F. (2024) Efficacy of Radiofrequency in Lumbar Facet Joint Pain: A Systematic Review and Meta-Analysis of Placebo-Controlled Randomized Controlled Trials. La Radiologia Medica, 129, 794-806. https://doi.org/10.1007/s11547-024-01809-8
[24]
Maas, E.T., Ostelo, R.W., Niemisto, L., Jousimaa, J., Hurri, H., Malmivaara, A., et al. (2015) Radiofrequency Denervation for Chronic Low Back Pain. Cochrane Database of Systematic Reviews, No. 10, CD008572. https://doi.org/10.1002/14651858.cd008572.pub2
[25]
Manchikanti, L., Malla, Y., Wargo, B.W., Cash, K.A., Pampati, V. and Fellows, B. (2012) Complications of Fluoroscopically Directed Facet Joint Nerve Blocks: A Prospective Evaluation of 7,500 Episodes with 43,000 Nerve Blocks. Pain Physician, 2, E143-E150. https://doi.org/10.36076/ppj.2012/15/e143
[26]
Kim, C.H., Issa, M.A. and Vaglienti, R.M. (2020) Intra-Articular Facet Joint Steroid Injection-Related Adverse Events Encountered during 11,980 Procedures. Pain Physician, 23, E93-E99.
[27]
Konai, M.S., Vialle, E.N., Bettega, G., et al. (2019) Effectiveness of Hydrodissection for Treatment of Superior Cluneal Nerve Entrapment. Pain Physician, 22, E9-E14.
[28]
Ashmore, Z.M., Bies, M.M., Meiling, J.B., Moman, R.N., Hassett, L.C., Hunt, C.L., et al. (2022) Ultrasound-Guided Lumbar Medial Branch Blocks and Intra-Articular Facet Joint Injections: A Systematic Review and Meta-Analysis. PAIN Reports, 7, e1008. https://doi.org/10.1097/pr9.0000000000001008
[29]
Nisolle, M., Ghoundiwal, D., Engelman, E., El Founas, W., Gouwy, J., Guntz, E., et al. (2023) Comparison of the Effectiveness of Ultrasound-Guided versus Fluoroscopy-Guided Medial Lumbar Bundle Branch Block on Pain Related to Lumbar Facet Joints: A Multicenter Randomized Controlled Non-Inferiority Study. BMC Anesthesiology, 23, Article No. 93. https://doi.org/10.1186/s12871-023-02029-9
[30]
Cohen, S.P., Bhaskar, A., Bhatia, A., Buvanendran, A., Deer, T., Garg, S., et al. (2020) Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain from a Multispecialty, International Working Group. Regional Anesthesia & Pain Medicine, 45, 424-467. https://doi.org/10.1136/rapm-2019-101243
