Cervical Steroid Injections

Cervical epidural steroid injections (CESIs) are a frequently used treatment for neck and head chronic pain syndromes. Chronic neck pain and cervical radiculitis are the most commonly treated condition with CESIs. Headaches and cervical spinal stenosis may also benefit from this treatment modality.

Cervical radiculitis results from nerve compression in the neck (cervical spine) that causes radiating pain down an arm. The pain originates from cervical spinal nerves becoming irritated as they exit the spinal cord. The symptoms of cervical radiculitis often include numbness and pain. If a person develops weakness in this distribution it is termed radiculopathy. Cervical radiculitis can be caused by bulging cervical discs or cervical spondylosis, which results from arthritis in the facet joints. Both causes can often be effectively treated with CESIs.

What is the epidural space?

The membrane that covers the spine and nerve roots in the neck is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the neck, shoulder and arms. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract with the bony structure of the spine in some way.

What is an epidural and why is it helpful?

An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the neck, shoulders and arms. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.

What happens during the procedure?

An IV is started so that relaxation medication can be given. The patient is placed sitting in a chair and positioned in such a way that the physician can best visualize the neck using x-ray guidance. The skin on the back of the neck is scrubbed using 2 types of sterile scrub (soap). Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a small needle, using x-ray guidance into epidural space. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the epidural space. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.

What happens after the procedure?

Patients are then returned to the recovery area where they are monitored for 30-60 minutes. Patients are then asked to record the relief they experience during the next week on a post injection evaluation sheet. This will be given to the patient when they are discharged home. A follow-up appointment will be made for a repeat block if indicated. These injections are usually done in a series of three, about two weeks apart. The arms and hands may feel weak or numb for a few hours. This is to be expected, however it does not always happen.

General pre/post instructions

Patients can eat a light meal within a few hours before the procedure. If a patient is an insulin dependent diabetic, they must not change their normal eating pattern prior to the procedure. Patients may take their routine medications. (i.e. high blood pressure and diabetic medications). Patients should not take pain medications or anti-inflammatory medications the day of their procedure. Patients have to be hurting prior to this procedure. They may not take medications that may give pain relief or lessen their usual pain. These medicines can be restarted after the procedure if they are needed. If a patient is on Coumadin (blood thinners) or Glucophage (a diabetic medicine) they must notify the office so the timing of these medications can be explained.

Benefits of Cervical Steroid Injections

Cervical steroid injections are considered simple and relatively painless. Approximately 72% of patients experienced immediate pain relief in a 2007 research trial. The trial specifically evaluated the usefulness of a cervical interlaminar epidural steroid injection in patients with neck pain and cervical radiculopathy (Kwon 2007). If pain relief is only moderately achieved with the first injection, a series of injections is typically attempted.

The use of multiple injections was studied by the Department of Anesthesiology and Intensive Care at the University of Pavia, Italy and they concluded that therapy with multiple injections provide better control of chronic cervicobrachial pain compared to that with a single injection (Pasqualucci 2007). Therefore, three to six injections yearly may be recommended by your pain specialist to maximize your pain relief.

The most important and greatest success achieved with the use of cervical steroid injections is the rapid relief of symptoms that allows you to become active again. With this pain relief, you often regain the ability to resume normal daily activities.

Risks of Cervical Steroid Injections

Cervical epidural steroid injections do have risks, but they are typically low. This pain treatment is considered an appropriate non-surgical treatment for many patients who suffer from neck pain and headaches. Complications of the injection can include bleeding, infection, headaches, and nerve damage. The medications used can also cause pharmacological complications. These risks include allergic reaction, high blood sugars, decreased immune response, and the potential for weight gain.

Along with proper technique, the procedural risks are reduced by using fluoroscopic guidance (x-ray) to position the needle and watch the medication spread during the procedure.