Ultrasound-Guided Hydro-Dissection of the Superficial Fascia for Cervical Myofascial Pain: A Case Series

The fascial system has recently gained attention for its potential role in various painful disorders. With the advancement of our understanding regarding the rich innervation of the fascia, it has emerged as a potential pain generator and a target for treatment in many cases. The superficial fascia presents a rich plexiform intrinsic neural network and runs within the subcutaneous fat tissue. It is pierced by several cutaneous nerves originating from the spine and reaching the dermo-epidermal complex along the posterior surface of the trunk. Unlike the deep fascia that envelopes the paraspinal muscles and for which several interventional techniques have been described, poor scientific data about ultrasound-guided procedures targeting the paravertebral superficial fascia are available. In this sense, this brief report describes three relevant cases whereby hydro-dissection of the cervical superficial fascia has been performed under ultrasound guidance to manage myofascial pain non-responsive to first-line conservative treatments. Likewise, we discuss the potential role of this often-forgotten anatomical structure in chronic cervical myofascial pain, cervicogenic dizziness, and paresthesias with non-dermatomal distribution of the cervical and periscapular region.