Cervical Epidural Steroid Injections involve the injection of medicine, usually a local anesthetic and/or steroid, into the epidural space of the cervical spine. Spine specialists often use image guidance with a contrast dye—called fluoroscopy—to ensure the medicine goes to the right place. Fluoroscopy uses a
Two Types of Cervical Epidural Steroid Injections
The needle can enter the epidural space through a transforaminal approach or interlaminar approach. Big words but, like “epidural,” they just refer to where in the cervical spine the needle goes.
- Transforaminal epidural injections, sometimes called selective nerve root blocks, are performed by entering the epidural space through the opening through which the nerve root (which branches from the spinal cord) exits. That space is known as the intervertebral foramen. The term selective nerve root blocks are typically reserved for cases when multiple nerve roots are being compressed and the injection is being used in a diagnostic manner to identify which nerve root is the pain generator.
- The needle in an interlaminar epidural injection goes through the opening that exists between the lamina of two adjacent vertebra to access the epidural space. Similar to the medieval suits of armor that were constructed by overlapping bands of metal, the lamina are bony projections that overlap the lamina from the adjacent vertebrae and form a portion of spinal canal.
Who Is a Candidate for Cervical Epidural Steroid Injection?
Cervical epidural steroid injections may be appropriate for someone who has severe neck pain with pain, numbness, weakness, or altered sensation in the arm, shoulder, or region between the scapula (shoulder blades). In most cases, cervical epidural steroid injections are reserved as a second-line treatment for people who have had neck pain that persists for more than 4 weeks despite conservative treatment such as physical therapy, chiropractic care, or medical management such as NSAIDs or acetaminophen).
The source of the pain will determine if an injection may be appropriate. The patient’s past medical and surgical history, pain history, physical exam findings, and results of an imaging study such as a computed tomography (CT) or magnetic resonance imaging (MRI) scan, or a nerve test such as an electromyography (EMG) test all play a role in finding the source of the pain.
If a spine specialist thinks nerve compression by a disc herniation, spondylolisthesis (i.e. shifting of one vertebral level), scarring, or arthritic changes is causing the pain, then a cervical epidural steroid injection may be appropriate. If the pain is thought to be due to an infection or cancer, then a cervical epidural steroid injection is unlikely to be recommended.
What Are the Potential Benefits?
The effects of cervical epidural steroid injections can be tough to sum up because they depend on a number of variables, such as:
- Duration of symptoms
- Cause of symptoms
- Additional treatment
…and more.
Broadly speaking, more than 50% of people will have at least 50% improvement in their pain for a minimum of 4 weeks, with some people experiencing relief up to 6 months. Pain that radiates to the arm is more consistently relieved than pain that localizes only to the neck. There are no major differences in outcomes between the transforaminal and interlaminar approaches.
Pain and overall patient satisfaction are improved when injections are part of a comprehensive treatment plan that includes additional measures such as physical therapy and pain medicine. There are conflicting reports as to whether cervical epidural injections decrease the need for surgery.
What Are the Possible Risks?
The most common complications associated with cervical epidural injections tend to be minor and temporary. They include:
- Headache
- Facial flushing
- Lightheadedness
- Rash
- Increase in neck pain
- Prolonged numbness
Major complications are rare, but they can be catastrophic. These major complications include death, paralysis, stroke, and infection. Most reports conclude that they occur in less than 1% of all people undergoing injections. They are thought to occur as a result of direct spinal cord penetration by the needle, bleeding into the spinal canal, or inadvertent injection of the medicine into the blood vessels. Surgical societies and facilities have guidelines in place to limit these complications.
Cervical epidural injections are a commonly used, and potentially powerful tool in the treatment of persistent, severe neck pain. Many factors need to be taken into consideration when determining whether these types of injections are appropriate for a specific individual and whether the potential risks are outweighed by the potential benefits.