Cervical Steroid Injections
Cervical epidural steroid injections (CESIs) are a
frequently used treatment for neck and head chronic pain
syndromes. Chronic neck pain and
radiculitis are the most commonly treated condition with
CESIs. Headaches and cervical
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
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
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
Risks of Cervical Steroid
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