Cervical Steroid Injection

What is a cervical epidural steroid injection?

A cervical steroid injection uses both an injection of both a steroid to control inflammation and a long-lasting anesthetic for pain relief. These injections are typically delivered into the cervical spine, the seven vertebrae that make up the neck portion of your spine. The injection is placed in the dura of the cervical spine. This is the space between the spinal cord and the vertebrae.

Cervical epidural steroid injections are a minimally-invasive procedure that can help relieve pain for some patients with severe or chronic neck and upper extremity pain. For many, it may help them avoid spinal surgery.

What conditions can a cervical epidural steroid injection help with?

Cervical steroid injections are simple and relatively painless, but they can help with some very painful conditions. These include:

• Neck pain
• Upper back pain
• Shoulder pain
• Cervical spinal stenosis
• Degenerative disc disease
• Herniated or bulging discs

Patients who experience neck pain or upper body pain that originates in the cervical spine typically feel pain or discomfort that radiates across the tops of their shoulders and moves into their arms and hands. This radiating pain is referred to as cervical radiculitis or radiculopathy.

As with sciatic pain experienced in the lower extremities, cervical radiculitis may feel like:

• Shooting pain
• Pins and needles in the shoulders, arms, and hands
• Numbness or weakness in the arms and hands

This type of pain occurs when a nerve in your neck is compressed or impinged due to any of the conditions listed above.

Although cervical epidural steroid injections are generally administered after more conservative treatments have failed, they can help you avoid cervical spinal surgery when your pain is intractable.

An overview of the cervical epidural steroid injection procedure

On the day of the procedure, you may receive a mild IV sedative to help you relax, especially if you are anxious about it. Talk to your doctor about any questions or concerns you have. Your healthcare team is there to help you feel more at ease.

The area to be injected will be numbed with a local anesthetic. Your doctor will use fluoroscopic guidance to position a thin needle in the epidural space, injecting a dye first to ensure that the medication is in the right place. This helps provide more targeted pain relief and can minimize potential risks.

Once the needle is in place, medications are injected. The medications include both a long-lasting steroid and a local anesthetic, usually lidocaine or bupivacaine. Steroids can help reduce inflammation and irritation, and the anesthetic disrupts pain messages to the brain.

The entire procedure usually takes less than 15 minutes. You can learn more about the procedure in the following video.

Side effects and risks

This pain treatment is considered an appropriate non-surgical treatment for many patients who suffer from neck pain. As with all procedures, cervical epidural steroid injections do have risks. They are typically rare, though.

Complications of the injection can include bleeding, infection, headaches, and nerve damage. The medications injected may also cause complications, with risks that include allergic reaction, high blood sugar, decreased immune response, and the potential for weight gain.

Proper positioning of the needle using fluoroscopic guidance helps to minimize these risks. Talking to your doctor about any and all allergies or past adverse reactions can also help.

Recovery

Patients typically experience immediate pain relief that diminishes in the first 24 hours as the local anesthetic wears off. This is normal, so take the day off and follow your doctor’s instructions for aftercare. These might include:

• Ice packs on the injection site
• Over-the-counter pain medications
• Rest

You should be able to resume your normal activities after the first day, but talk to your doctor if pain persists past a week.

Could a cervical epidural steroid injection help me?

A small-scale study in 2018 found that the majority of patients experienced complete pain relief within ten minutes of their cervical epidural steroid injection, relief that was still present at six months.

An earlier study found that most patients achieved profound pain relief that was more prolonged with the use of follow-up injections. If pain relief is only moderate with the first injection, your doctor may attempt a series of injections. Your pain specialist may recommend three to six injections yearly to maximize your pain relief.

The most important and greatest success possible with the use of cervical steroid injections is the rapid relief of symptoms that can allow you to become active again. In many cases, this type of pain relief combines with other therapies, like physical therapy, for more lasting relief.

The amount and duration of pain relief varies from person to person. Some have limited relief while others can benefit long-term. Many of the patients who receive these injections for management of their chronic neck pain enjoy improved function and diminished pain, especially when these injections are combined with other treatments (e.g., physical therapy).

References

1. Epidural Local Anesthetic Plus Corticosteroid for the Treatment of Cervical Brachial Radicular Pain: Single Injection Versus Continuous Infusion. Pasqualucci A, Varrassi G, Braschi A, Peduto VA, Brunelli A, Marinangeli F, Gori F, Colò F, Paladini A, Mojoli F. PMID: 17710003
2. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025
3. Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors. Skeletal Radiol. 2007 May;36(5):431-6. Epub 2007 Mar 6 Kwon JW, Lee JW, Kim SH, Choi JY, Yeom JS, Kim HJ, Kwack KS, Moon SG, Jun WS, Kang HS