Your Health

Cervical Epidural Injection

Definition

The cervical spine is the part of the spine in your neck. The spinal cord sits inside a tunnel created by the vertebrae (bones making up the spine). It is also protected by a soft layer of tissue called the dura. The epidural space is the area between the bony canal and the dura layer of the spinal cord.

An epidural injection is a procedure to deliver medication into this epidural space. The medication may include an anesthetic that will numb the pain and a steroid that can decrease swelling and irritation.

Cervical Spine
Cervical Spine
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Reasons for Procedure

An epidural injection may be done if you have pain in your neck and upper limb that is not responding to conservative treatment, such as oral medications and physical therapy.

Damage to local joints or discs of the spine can irritate the nerves exiting the spinal cord. This can cause inflammation around the nerves, which leads to pain. The pain may be in the neck or may travel down to the shoulders and arms, and even to the hands and fingers.

The injection may provide relief for a few weeks or even a couple months depending on the exact cause of pain.

This procedure may help manage the pain until the injury that caused the nerve irritation has time to heal.

Possible Complications

Potential problems are rare. But, all procedures have some risk. Your doctor will review potential problems, like:

  • Increase in pain
  • Bleeding or fluid leakage in spinal canal
  • Infection
  • Spinal headaches
  • Nerve damage
  • Allergic reaction to the medication used, such as hives, lightheadedness, low blood pressure, or wheezing

Smoking may increase your risk of complications.

Your doctor may not want to do this injection if you have:

  • Not tried other conservative treatment
  • Had success with conservative treatment
  • Allergies to the local anesthetic, x-ray contrast, or medications being used
  • Local skin infection
  • An infection
  • Bleeding disorder or take blood-thinning medication
  • Pain that is due to infection or malignancy
  • Uncontrolled high blood pressure or diabetes
  • Unstable angina or heart failure

What to Expect

Prior to Procedure

Your doctor may begin with conservative treatment, such as rest, medication, physical therapy, and exercise.

Before the procedure you may need:

  • A physical exam
  • Imaging tests to evaluate the spinal structures with x-rays or an MRI scan
  • To discuss allergies that you may have to the anesthetic, pain medication, or latex

In addition, talk to your doctor about your medications. You may have to stop taking some medications up to one week or more before the procedure.

Additional considerations include:

  • Your doctor may ask you to avoid food or drink a few hours before the procedure.
  • You will need someone to drive you home after the procedure.

Anesthesia

You will be awake during this procedure. A local anesthetic will be used to numb the skin before the injection. Your doctor may also give you medication to help you relax.

Description of Procedure

You may have devices attached to help monitor your blood pressure, heart, and oxygen levels. You will be asked to lie on your stomach or side on an x-ray table or sit in a chair. The skin around the injection site will be cleansed. A local anesthetic will be given to numb the area.

The doctor will inject a contrast dye. This dye will help highlight the area to guide the needle. This is done using a type of x-ray called fluoroscopy. Next, when the doctor has reached the epidural space, the steroid will be delivered.

Immediately After Procedure

The nurse will place a small bandage over the injection site. You may be able to go home after being observed by the nurses.

How Long Will It Take?

The injection only takes a few minutes. The entire procedure may be 30-60 minutes.

How Much Will It Hurt?

There is local discomfort as the numbing medication first goes in. But the rest of the procedure should not be painful. Once the injected anesthetic wears off, you may have some discomfort.

Post-procedure Care

At the Care Center

Your doctor will assess your level of pain relief.

At Home

You will have to reduce your activity level for the first day or so. You can slowly increase your activity as tolerated or by your doctor's instructions. You can apply ice to the affected area to relieve swelling and discomfort. Pain can be managed with medications. Proper care of the insertion site can help prevent infection. If you have diabetes, monitor your blood sugar levels more carefully a few weeks after an injection. The medication that was injected may cause elevated blood sugar levels.

Call Your Doctor

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:

  • Severe pain or headache
  • Fever or chills
  • Increased arm weakness or numbness
  • Problems swallowing
  • Redness, swelling, increasing pain, bleeding, or discharge from the injection site

If you think you have an emergency, call for medical help right away.

Revision Information

  • American Chronic Pain Association

    http://www.theacpa.org

  • Ortho Info—American Academy of Orthopaedic Surgeons

    http://www.orthoinfo.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • The Arthritis Society

    http://www.arthritis.ca

  • Cervical epidural. University of Wisconsin School of Medicine and Public Health: Radiology Department website. Available at: https://www.radiology.wisc.edu/sections/msk/interventional/Cervical%20epidural/index.php. Accessed March 19, 2012.

  • Cervical epidural steroid injection. University of California San Diego website. Available at: http://health.ucsd.edu/specialties/cppm/injections/Pages/cervical-epidural-steroid-injection.aspx. Accessed March 18, 2012.

  • Cervical radiculopathy: Non-operative treatments and cervical epidural steroid injection. Hospital for Special Surgery website. Available at: http://www.hss.edu/conditions%5Fcervical-radiculopathy-nonoperative-treatments-epidural.asp#.VJMhbtLF-So. Accessed March 18, 2012.

  • Epidermal injections. Radiological Society of North America Radiology Info website. Available at: http://www.radiologyinfo.org/en/info.cfm?pg=epidural. Accessed March 18, 2012.

  • Spinal injections. Rehabilitation Institute of Chicago website. Available at: http://www.ric.org/conditions/spine-and-sports-rehabilitation/spinal-injections. Accessed March 19, 2012