Ultrasound-Guided Hydrodissection Combined with Small Pluripotent Stem Cells (SPSCs) and SPSC-Derived Exosomes in Chronic Nerve Pain: A Clinical Case Series

Abstract

Background: Chronic peripheral nerve pain is a common and often disabling condition associated with nerve entrapment, post-inflammatory neuropathic irritation, mechanical tethering, and radicular or peripheral nerve-related pain syndromes. Conventional treatments, including pharmacological therapy, corticosteroid injections, and physical rehabilitation, may provide incomplete or temporary relief. Ultrasoundguided hydrodissection has emerged as a minimally invasive technique intended to mechanically separate irritated or entrapped nerves from surrounding fascia, adhesions, or fibrotic tissue. In parallel, regenerative approaches using small pluripotent stem cells (SPSCs) and SPSC-derived exosomes may offer biological effects through paracrine signaling, immunomodulation, and support of tissue repair.

Case presentations: Six patients with chronic peripheral nerve pain of varying etiologies, including suspected nerve entrapment, postinflammatory neuropathic pain, and disc herniation-associated nerve irritation, were treated with ultrasound-guided hydrodissection combined with local administration of autologous SPSCs and SPSC-derived exosomes. All patients had persistent symptoms despite prior conservative management. The procedure involved ultrasound identification of the symptomatic nerve or perineural target area, hydrodissection to separate the nerve from adjacent tissue planes, and targeted local administration of SPSCs and exosomes. Across the case series, patients reported clinically meaningful reductions in pain and improvements in function during follow-up. No serious adverse events were observed.

Conclusion: This preliminary case series suggests that ultrasound-guided hydrodissection combined with SPSCs and SPSC-derived exosomes may represent a promising multimodal approach for selected patients with chronic peripheral nerve pain. The rationale is based on combining mechanical nerve release with potential regenerative, anti-inflammatory, and paracrine effects. These findings should be interpreted cautiously because of the uncontrolled design, small sample size, heterogeneous indications, and absence of blinding. Controlled prospective studies are warranted to evaluate efficacy, safety, mechanisms of action, and longterm outcomes.