Cervical Epidural Injection

Therapeutic and Diagnostic Benefits for Neck Pain

A cervical epidural injection is a safe and effective minimally invasive treatment. This type of spinal injection serves two purposes: (1) reduces nerve inflammation, calms symptoms, aids healing and, (2) provides important diagnostic information.

The procedure involves injecting a local anesthetic and corticosteroid into the epidural space. A corticosteroid is a powerful, slow-releasing, and long-lasting anti-inflammatory medication effective in reducing inflammation. The epidural space is between the protective membrane (dura mater) containing the spinal fluid, spinal cord, and the bony spinal canal. After the medication is injected, it flows and coats the nerve roots.

From a diagnostic viewpoint, if the cervical epidural injection relieves symptoms (i.e. pain), it could mean the nerve targeted is a potential pain generator. Such diagnostic information is beneficial to your doctor and his treatment plan.

Causes of Neck Pain

There are many spinal problems that can cause nerve irritation in the neck. As depicted in the illustration, a herniated disc or bone spurs (osteophytes) can compress fragile spinal nerve roots.

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Basics about Cervical Spinal Nerves

In the cervical spine there are 8 pairs of spinal nerves. Each pair of nerves provides sensation and function to parts of the body. Just as the levels of the cervical spine are abbreviated, the spinal nerve pairs are numbered in a corresponding way. C1 is the area between the skull and first cervical vertebra (also abbreviated C1). C8 exits the spinal canal between the last cervical vertebra (C7) and the first thoracic vertebra (T1).

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Each pair of nerve roots exit the spinal column and branch out into the body forming the peripheral (outer) nervous system. These nerves innervate the upper part of the body and enable movement (motor function) and feeling (sensory function). The illustration depicts this pattern called dermatomes. Your doctor uses the dermatomal pattern to help diagnose the location of your spinal problem based on where you have pain or weakness.

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From your symptoms, medical history, physical and neurological examination, and imaging study findings (X-ray, MRI), your doctor determines which spinal nerve root(s) may be generating pain and other symptoms.

Patient Procedure Preparation

In advance of your procedure appointment, our medical team provides you with instructions specific to you and medications you regularly take.

If you take blood thinning medication, such as Coumadin, Plavix, Prodaxa, aspirin, etcetera, please notify our medical team. Certain drugs must be stopped several days before your procedure.

Possible Risks and Complications

Upon arrival at the treatment facility, you are received by our nurses in the preoperative area. If necessary, medications to relax you are given intravenously (IV).

In the operating room, you are positioned in bed in such a way to stabilize your head / neck and keep you comfortable. Next, the skin area is cleaned with a sterile soap. A local anesthetic is injected and given time to take effect.

Using fluoroscopic guidance (real time x-ray), the doctor proceeds with the procedure and places the needle tip at the target area. The doctor confirms the needle tip is properly positioned visually under fluoroscopy in different angles of view. He then injects a small amount of contrast (dye) to ensure correct spread. Next, a low volume anesthetic / corticosteroid solution is injected into the specific location. Our medical team is dedicated to making you as comfortable as possible. A small band-aid covers the injection site.

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Sample of Dr. Assil's view during a cervical epidural injection

Usually, the procedure takes 15 to 20 minutes. Afterward, in the recovery area, you are closely monitored by our nurses for about 25 minutes.

Before you are released home, our medical team provides you with written home care instructions. Some patients experience 2 to 3 days of discomfort after the procedure. This is normal and does not necessarily mean the corticosteroid is not taking effect.

Conclusion

A member of our medical team will telephone you 24 to 48 hours after your cervical epidural injection to follow-up. We recommend you keep a daily journal of your pain level and other symptoms following your procedure. Please be specific and keep in mind where pain and symptoms are in relationship to the injection site. The pain diary will help you provide your doctor with detailed information about your treatment progress when you come back for your follow-up office visit.

Download Epidural Injections (with sedation) Post-Procedure Care Form.

You will be provided with specific discharge instructions following your procedure customized to your condition. The attached instructions are provided only as an indication for pre-planning purposes and do not replace or supercede the specific discharge instructions which will be provided to you by the Recovery Nurse.