AB236. SOH25_AB_191. Hydrodissection for the treatment of chronic occipital neuralgia following cervical decompression surgery: a case report

Background: Occipital neuralgia is a chronic headache disorder characterized by sharp, lancinating pain in the distribution of the greater and lesser occipital nerves. This condition may develop or persist after cervical spine surgery, complicating management. Hydrodissection, a minimally invasive technique involving injection of fluid to separate fascial layers and release entrapped nerves, has emerged as a potential treatment for occipital neuralgia. We present the case of a 25-year-old female with refractory occipital neuralgia following cervical decompression surgery several years prior. Despite extensive conservative therapies, including medications and physical therapy, she continued to experience debilitating occipital pain.

Methods: The patient underwent ultrasound-guided occipital hydrodissection as a targeted approach to address perineural inflammation and nerve entrapment. Hydrodissection of the trapezius, splenius capitis, and semispinalis muscles was also performed on the right side. A low concentration (5%) dextrose solution was used to free the occipital nerves from surrounding scar tissue and muscle adhesions. The procedure was performed in an outpatient setting.

Results: Following the hydrodissection procedure, the patient experienced marked improvement in headache frequency and intensity, with sustained improvement over two months of follow-up. Functional outcomes, including range of motion and daily activities, improved substantially. No complications were reported.

Conclusions: This case supports the potential role of dextrose hydrodissection as a safe, minimally invasive treatment option for occipital neuralgia, particularly in patients with complex pain histories and previous cervical spine surgery. Hydrodissection offers an alternative to more invasive interventions and warrants further investigation in the management of post-surgical occipital neuralgia.

Keywords: Headache; hydrodissection; occipital neuralgia; pain; ultrasound