Injections of steroids into the cervical spine can alleviate neck pain and radiating pain.
Many people all over the world suffer from neck pain. While not as common as back pain, neck pain can have a significant impact on a person’s quality of life and ability to work due to sleep disruptions, radiating pain, mental health issues, and other factors. Neck pain, like back pain, is difficult to treat without first determining the source (called the pain generator).
Neck injections can help with:
- Using a diagnostic injection to pinpoint the source of the pain
- Using a therapeutic injection to relieve pain
In some cases, an injection can serve as both a diagnostic and a therapeutic purpose.
Cervical epidural steroid injections, medial branch blocks (MBBs), and facet joint injections are the most commonly used injections. Learn about cervical epidural steroid injections, what they treat, and the scientific research that supports their risks and benefits.
What Exactly Is Cervical Epidural Steroid Injection?
Let us begin by dissecting the phrase “cervical epidural steroid injection.” The last one is probably the most familiar: Injection is the administration of medicine via a needle. Then there’s cervical, as in the cervical spine, also known as the neck.
Epidural. This one is a little more difficult. The dura is the soft tissue envelope that surrounds the spinal cord, nerve roots, and cerebrospinal fluid. The term “epidural” refers to the administration of medication into the space surrounding the dura. Steroids are also potent anti-inflammatory medications.
As a result, cervical epidural steroid injections involve the injection of medicine, typically a local anesthetic and/or steroid, into the cervical spine’s epidural space. To ensure that the medicine gets to the right place, spine specialists frequently use image guidance with a contrast dye, known as fluoroscopy. Fluoroscopy makes use of a
There are two kinds of cervical epidural steroid injections.
The needle can be inserted into the epidural space via a transforaminal or interlaminar approach. Big words, but, like “epidural,” they simply refer to where the needle is inserted in the cervical spine.
- Transforaminal epidural injections, also known as selective nerve root blocks, are administered by entering the epidural space through the opening where the nerve root (which branches from the spinal cord) exits. The intervertebral foramen is the name given to this space. The term selective nerve root blocks is usually reserved for situations in which multiple nerve roots are compressed and the injection is used to determine which nerve root is causing pain.
- To access the epidural space, the needle in an interlaminar epidural injection passes through the opening between the lamina of two adjacent vertebrae. The lamina are bony projections that overlap the lamina from the adjacent vertebrae and form a portion of the spinal canal, similar to medieval suits of armor that were constructed by overlapping bands of metal.
Who Should Get Cervical Epidural Steroid Injections?
Cervical epidural steroid injections may be appropriate for someone who has severe neck pain that is accompanied by pain, numbness, weakness, or altered sensation in the arm, shoulder, or region between the scapulae (shoulder blades). In most cases, cervical epidural steroid injections are reserved as a last resort for people who have had neck pain for more than four weeks despite conservative treatment (such as physical therapy, chiropractic care, or medical management with NSAIDs or acetaminophen).
The source of the pain will determine whether or not an injection is necessary. The patient’s past medical and surgical history, pain history, physical exam findings, and the 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 contribute to determining the source of the pain.
A cervical epidural steroid injection may be recommended if a spine specialist believes that nerve compression caused by a disc herniation, spondylolisthesis (shifting of one vertebral level), scarring, or arthritic changes is causing the pain. A cervical epidural steroid injection is unlikely to be recommended if the pain is thought to be caused by an infection or cancer.
What Are the Potential Advantages?
The effects of cervical epidural steroid injections can be difficult to summarize because they are dependent on a number of factors, including:
- Symptom duration
- Symptom cause
- Additional treatment…
and much more.
More than half of people will have at least 50% improvement in their pain for at least 4 weeks, with some people experiencing relief for up to 6 months. Pain that radiates to the arm is consistently relieved more consistently than pain that only radiates to the neck. The outcomes of the transforaminal and interlaminar approaches are not significantly different.
When injections are part of a comprehensive treatment plan that includes other measures such as physical therapy and pain medication, pain and overall patient satisfaction improve. There is disagreement about whether cervical epidural injections reduce the need for surgery.
What Are the Potential Dangers?
The most common complications from cervical epidural injections are minor and temporary. They are as follows:
- Facial flushing
- Neck pain
- Prolonged numbness
Major complications are uncommon, but they can be disastrous. Death, paralysis, stroke, and infection are among the major complications.
According to most reports, they occur in less than 1% of all people who receive injections. They are thought to occur as a result of direct spinal cord needle penetration, spinal canal bleeding, or inadvertent injection of medicine into blood vessels. Guidelines are in place at surgical societies and facilities to limit these complications.
Cervical epidural injections are a common and potentially effective treatment for chronic, severe neck pain. Many factors must be considered when deciding whether these types of injections are appropriate for a particular individual and whether the potential risks outweigh the potential benefits.
Are you thinking about getting a cervical epidural spinal injection? Find a spine specialist in your area who can assist you.