Percutaneous Hydrotomy: Effectiveness, Safety and Scientific Evidence

One particularly relevant study was completed in 2022 by Dr Myriam Semani as part of the Inter-University Diploma in Mesotherapy at Pitié-Salpêtrière, Paris VI.

The prospective multicentre study followed 47 patients with chronic low-back pain, with or without associated sciatica.

Their symptoms had persisted for approximately 29 months on average.

Many had already received other treatments:

• 92% had previously received physiotherapy
• 40% had received infiltrations
• some had previously undergone spinal surgery

The study used a closely related large-dilution mesoperfusion approach involving substantial volumes of physiological saline administered through superficial locoregional points.

Its use of substantial dilution, physiological saline and superficial locoregional administration makes the study particularly relevant to the scientific discussion surrounding percutaneous hydrotomy.

Pain decreased substantially

Assessment	Mean pain score
Before treatment	7.8 / 10
Day 30	3.6 / 10
Day 60	2.1 / 10
Day 90	1.1 / 10 among participants with available follow-up data

The study reported an improvement in individual pain scores in 96% of the patients included.

This does not mean a 96% universal success rate. It means that improvement in the individual pain score was recorded in 96% of the patients included in the study.

Functional disability also improved substantially.

The median Quebec functional score decreased from approximately 50 before treatment to 14 at the final assessment, and the use of analgesic medication also decreased during follow-up.

These are clinically important changes.

What should we understand from these results?

The study was prospective and conducted across several centres, which strengthens the clinical relevance of the observations.

It did not include a randomized control group, and follow-up became less complete later in the study. The day-90 average therefore applies only to patients for whom follow-up data were available at that point.

These factors are important when interpreting the results precisely.

They do not remove the strong observed signal in pain and function.

Instead, the study provides an encouraging foundation for larger controlled research into large-dilution and hydrotomy-related approaches.

The scientific literature around superficial locoregional injection treatments has also expanded.

These studies do not investigate percutaneous hydrotomy itself and should therefore be viewed as supporting evidence rather than direct hydrotomy trials.

A 2024 study of 130 patients with chronic low-back pain

A 2024 study evaluated spinal locoregional treatment in 130 patients with chronic low-back pain.

Both treatment groups experienced significant improvements in pain and disability, and the improvements were maintained during follow-up.

No adverse effects were reported following the procedures.

Its relevance lies in the broader scientific evidence showing that carefully administered superficial locoregional treatment can produce measurable improvements in chronic low-back pain and function.

More than 800 patients reviewed in 2025

A 2025 scientific review examined nine studies involving more than 800 patients with chronic back-pain syndromes.

Across the studies reviewed, the authors found a consistent positive effect on pain and functional outcomes.

No serious adverse events were reported across the studies included in the review.

These findings add an increasingly substantial scientific context around superficial locoregional treatment of chronic spinal pain.

Knee osteoarthritis is another particularly interesting area.

Hydrotomy-specific clinical and university work has reported improvements in pain and function and has also generated interest in structural and cartilage-related changes.

Broader controlled research on locoregional treatments provides additional evidence.

A randomized controlled study published in 2023 included 43 patients and 56 knees with mild-to-moderate knee osteoarthritis.

Both groups improved, but the active-treatment group showed significantly greater improvements at later follow-up in:

• activity-related pain
• WOMAC pain
• WOMAC physical function
• total WOMAC score

This research provides relevant supporting scientific context for locoregional treatment in knee osteoarthritis.

For a detailed look at this indication, read our guide to Percutaneous Hydrotomy for Knee Osteoarthritis: Treatment, Results and Evidence.

The intervertebral disc is naturally rich in water.

Its central nucleus pulposus contains proteoglycans that help attract and retain water. Healthy disc function therefore depends partly on the ability of the disc to maintain its hydration.

During normal daily activity, discs lose some water under mechanical loading and regain part of it during periods of reduced loading.

Degenerative disc disease changes this process.

Changes can include:

• reduced proteoglycan content
• alterations in collagen
• changes in the extracellular matrix
• reduced ability to retain water
• progressive loss of disc hydration

The 2022 Semani research also describes the hydrophilic properties of the intervertebral disc and discusses chronic dehydration as part of the degenerative process.

This makes tissue hydration particularly relevant when considering therapeutic approaches to degenerative disc conditions.

Yes.

The aim is to help reduce pain and improve mobility and tolerance of activity.

The goal is not to insert a needle into the intervertebral disc.

The needles remain superficial.

Instead, the treatment aims to improve the local extracellular and biological environment through locoregional hydration and, depending on the protocol, micronutritional and therapeutic support.

Within hydrotomy practice, treatment can therefore aim to support:

• local extracellular hydration
• the biological environment surrounding degenerative tissues
• tissue nutrition
• repair processes

This is particularly interesting because dehydration is itself an important component of degenerative disc pathology.

Our guide to back pain, herniated discs and sciatica without surgery explains how these situations are assessed.

Research is still looking at whether hydrotomy has any effect on tissue structure; current data do not allow us to say so.

Patients report improvements in pain and mobility. No controlled study shows so far that hydrotomy rehydrates or regenerates a disc or cartilage, so we do not promise it.

Patients report improvements in pain and mobility. No controlled study shows so far that hydrotomy rehydrates or regenerates a disc or cartilage, so we do not promise it.

These observations suggest that, in some patients, the effects of treatment can extend beyond temporary pain reduction.

They are particularly interesting when accompanied by improvements in mobility and function.

Structural regeneration is more complex to study than pain reduction, and no controlled study has demonstrated it so far.

Large controlled studies using standardized MRI assessment would allow researchers to determine more precisely:

• how frequently structural changes occur
• which types of degeneration respond best
• the magnitude of the changes
• how long the changes persist
• how structural improvement relates to pain and function

Research is still looking at whether hydrotomy has any effect on tissue structure; current data do not allow us to say so.

The International Association of Percutaneous Hydrotomy has published clinical radiological examples from patients treated with the technique, including one documented before-and-after pair.

These include cases involving:

• disc dehydration
• disc protrusion
• disc herniation
• degenerative disc disease
• calcific tendon disorders
• other degenerative musculoskeletal conditions

In some of these examples, visible structural differences can be observed between imaging performed before treatment and follow-up imaging after treatment.

Clinical imaging example: disc dehydration and protrusion

Before-and-after MRI: L5-S1 disc herniation

These imaging observations are particularly interesting because they complement the improvements reported in pain, mobility and function.

Research is still looking at whether hydrotomy has any effect on tissue structure; current data do not allow us to say so.

Individual before-and-after images cannot tell us how frequently these structural changes occur across all treated patients.

Larger prospective studies using standardized MRI assessment can help quantify these effects more precisely.

What the existing images demonstrate is that structural changes have been observed and documented radiologically in clinical hydrotomy practice.

International Association of Percutaneous Hydrotomy, AIHP. Individual clinical imaging examples. Treatment response varies between patients.

Research is still looking at whether hydrotomy has any effect on tissue structure; current data do not allow us to say so.

Hydrotomy practice has reported clinical improvement in osteoarthritis alongside structural and cartilage-related observations.

These findings are particularly relevant because osteoarthritis is not simply a pain condition.

It involves changes within the joint and its surrounding tissues, so a treatment strategy that aims to improve the local tissue environment has a broader objective than temporary pain suppression alone.

For the individual patient, however, the most important outcomes remain practical.

These can include:

• substantially less pain
• improved walking
• greater joint mobility
• easier stair climbing
• increased capacity for exercise
• greater independence
• return to activities previously limited by pain

Imaging can provide an additional layer of information when clinically relevant.

Clinical improvement and structural improvement should therefore be considered together rather than as interchangeable outcomes.

Percutaneous hydrotomy is a superficial injection technique.

Very fine needles are placed in or just beneath the skin rather than deeply into a joint, muscle or spinal disc.

The technique is generally well tolerated in clinical practice.

Temporary local effects can include:

• sensitivity at an injection point
• mild discomfort
• a small bruise
• temporary redness
• a local reaction

Safe practice depends not only on the technique itself but on how it is performed.

At Centre Algos, this includes:

• reviewing relevant medical history
• checking current medication
• identifying allergies
• assessing contraindications
• using sterile products
• using single-use equipment
• careful selection and dilution of substances
• strict hygienic and aseptic technique
• adapting the protocol to the individual patient

The wider published evidence on related locoregional techniques is also reassuring.

The 2024 study involving 130 people with chronic low-back pain reported no adverse effects following the procedures.

The 2025 review of more than 800 patients likewise reported no serious adverse events across the studies reviewed.

These findings add to the overall safety picture while recognizing that any injectable treatment should be performed with appropriate clinical assessment and technique.

The evidence surrounding percutaneous hydrotomy is best understood as a growing body of complementary clinical and scientific evidence.

Decades of clinical experience

Hydrotomy has been used clinically for several decades, with repeated observations of improvements in pain, mobility and function.

Hydrotomy-specific clinical and university work

Research and clinical documentation exist in osteoarthritis, chronic back pain and other musculoskeletal conditions.

These include pain and functional outcomes as well as structural and imaging observations.

Prospective large-dilution research

The 2022 multicentre study provides particularly encouraging prospective evidence in chronic low-back pain, with substantial observed improvements in pain and function.

Broader peer-reviewed evidence

A growing body of peer-reviewed research on related superficial locoregional approaches provides additional scientific support for measurable improvements in musculoskeletal pain and function.

Reported observations and the limits of the data

Patients report improvements in pain and mobility. No controlled study shows so far that hydrotomy rehydrates or regenerates a disc or cartilage, so we do not promise it.

Patients report improvements in pain and mobility. No controlled study shows so far that hydrotomy rehydrates or regenerates a disc or cartilage, so we do not promise it.

Together, these different levels of evidence create an increasingly meaningful picture of the clinical potential of the technique.

Future controlled studies can now build on this foundation to answer more detailed questions about patient selection, optimal protocols and structural outcomes.

Further research into percutaneous hydrotomy represents an opportunity to understand the treatment in greater detail.

Pain improvement can already be measured relatively easily.

Future studies can go further and examine:

• mobility
• function
• duration of improvement
• return to activity
• medication use
• quality of life
• changes in disc hydration
• cartilage and other structural outcomes
• standardized MRI changes
• which clinical profiles respond particularly well

Large prospective multicentre trials with standardized treatment protocols would be especially valuable.

Controlled imaging research could also help quantify some of the structural changes already observed in clinical practice.

The next scientific question is therefore increasingly not simply whether patients can improve, but how the clinical and structural effects can be measured, reproduced and understood in greater detail.

Scientific studies are important, but clinical effectiveness ultimately has to translate into meaningful improvement for the individual patient.

At Centre Algos, we therefore evaluate more than a pain score.

We look at questions such as:

Can you walk further?

Can you move more comfortably?

Can you climb stairs more easily?

Can you return to exercise?

Can you perform everyday activities that pain had made difficult?

Has your reliance on pain medication changed?

Has your overall function improved?

These functional outcomes are particularly important in chronic musculoskeletal conditions.

Percutaneous hydrotomy is also not necessarily used in isolation.

Depending on the patient and the condition, it can form part of a broader treatment strategy involving movement, rehabilitation and other appropriate therapeutic approaches.

Hydrotomy can therefore be introduced alongside movement and rehabilitation when clinically appropriate, rather than being reserved only for situations in which every other treatment has failed.

The objective is not simply to suppress pain.

It is to improve function, support recovery and help the patient return to a more active life.

Percutaneous hydrotomy has been used clinically for several decades and has accumulated substantial experience in osteoarthritis, persistent musculoskeletal pain, chronic back problems and degenerative conditions.

Patients can experience substantial improvements in pain, mobility and function.

Prospective research has reported marked improvements in chronic low-back pain, while additional peer-reviewed studies of related locoregional approaches provide further scientific support for improvements in pain and functional outcomes.

Patients report improvements in pain and mobility. No controlled study shows so far that hydrotomy rehydrates or regenerates a disc or cartilage, so we do not promise it.

Before-and-after imaging observations provide visible examples of these structural changes in clinical hydrotomy practice.

Larger controlled studies, particularly those using standardized imaging, can now help quantify these effects more precisely.

The scientific evidence therefore does not depend on one single study.

It is a developing picture built from decades of clinical experience, hydrotomy-specific work, prospective research, broader supporting scientific evidence and clinical and radiological observations.

For patients, this combination makes percutaneous hydrotomy an important treatment option worth considering when the clinical situation is appropriate.

At Centre Algos, treatment begins with understanding the problem, reviewing the investigations that have already been performed and deciding together whether percutaneous hydrotomy fits the individual treatment strategy.

Learn more about Percutaneous Hydrotomy at Centre Algos

Does percutaneous hydrotomy work?

Clinical experience includes substantial improvements in pain, mobility and function. Prospective research has also reported marked improvements in chronic low-back pain, while hydrotomy-specific clinical work and supporting scientific research continue to expand the evidence base.

Is there scientific evidence for percutaneous hydrotomy?

Yes. The evidence includes hydrotomy-specific clinical and university work, prospective research into closely related large-dilution treatment and broader peer-reviewed evidence on locoregional approaches. These different sources provide complementary information on pain and function. They do not demonstrate a regenerative effect.

Is percutaneous hydrotomy the same as mesotherapy?

No. Percutaneous hydrotomy has its own therapeutic concept in which local extracellular hydration, substantial dilution and targeted locoregional delivery play central roles. Some research on related techniques can provide supporting scientific context without being identical to hydrotomy.

Is percutaneous hydrotomy safe?

Percutaneous hydrotomy uses very fine superficial needles and is generally well tolerated in clinical practice. Temporary local discomfort, sensitivity, redness or bruising can occur. Safe treatment depends on appropriate patient assessment, sterile technique, practitioner training and careful selection of injectable substances.

Can percutaneous hydrotomy help chronic back pain?

Chronic back pain is an important application of hydrotomy-related large-dilution treatment. In a 2022 prospective multicentre study involving 47 people with chronic low-back pain, average pain decreased substantially and functional disability also improved.

Does percutaneous hydrotomy act on a worn disc?

The treatment is locoregional and superficial: the needle does not enter the disc. No controlled study shows that it rehydrates a degenerative disc; the aim is to help reduce pain and improve mobility.

What is known about hydrotomy's effect on the disc?

Patients report improvements in pain and mobility. No controlled study shows so far that hydrotomy rehydrates or regenerates a disc or cartilage, so we do not promise it.

Have structural changes actually been seen on scans?

Yes. Before-and-after imaging examples have been published within clinical hydrotomy practice, including cases involving disc dehydration, protrusion, herniation and degenerative spinal changes. Individual imaging examples do not establish how frequently these outcomes occur, but they document that structural changes have been observed radiologically.

Can hydrotomy help knee osteoarthritis?

Knee osteoarthritis is an important application of percutaneous hydrotomy. Clinical experience includes improvements in pain, function and mobility, while structural and cartilage-related changes have also been reported.

Does hydrotomy replace movement or rehabilitation?

No. Percutaneous hydrotomy can be combined with appropriate movement and rehabilitation. Improving pain, mobility and tissue function can make it easier for a patient to return to physical activity and participate effectively in rehabilitation.

• Semani M, 2022. Intérêt des grandes dilutions en mésothérapie dans la prise en charge des lombalgies chroniques. Technique de mésoperfusion. Inter-University Diploma in Mesotherapy, Pitié-Salpêtrière, Paris VI (PDF)
• Koszela K, et al. Efficacy and Safety of Spinal Collagen Mesotherapy in Patients with Chronic Low Back Pain in a Three-Month Follow-Up. 2024
• Scientific review of locoregional injection treatment in chronic back-pain syndromes, 2025
• Tseveendorj A, et al. Randomized controlled trial in knee osteoarthritis, 2023
• Faetani L, et al. Systematic review and meta-analysis of mesotherapy for musculoskeletal pain, 2021
• International Association of Percutaneous Hydrotomy. Scientific studies and clinical work (professional association material)
• International Association of Percutaneous Hydrotomy. Before-and-after clinical imaging examples

• Percutaneous Hydrotomy treatment page
• What Is Percutaneous Hydrotomy?
• Percutaneous Hydrotomy for Knee Osteoarthritis
• Back Pain, Herniated Discs and Sciatica Without Surgery
• Tendinopathy Without Cortisone