FAQs on Cervical Epidural Steroid Injection

A cervical epidural steroid injection (ESI) is a simple outpatient procedure used to treat neck pain and radiculopathy. With this procedure, the doctor injections a long-acting steroidal agent into the epidural space (space around the spinal cord).

What health conditions and disorders are treated with ESI?

The epidural steroid injection is used to treat several cervical spine disorders. These include:

  • Cervical herniated disc
  • Spinal stenosis
  • Degenerative disc disease
  • Bulging disc
  • Spondylolysis

What are the benefits of epidural steroid injections?

The cervical ESI procedure has many benefits. It is used to relieve radicular pain (nerve pain) associated with inflammation and irritation of a spinal nerve root. The ESI is also used to diagnose certain spinal conditions.

How do I prepare for the cervical ESI procedure?

Before the procedure, arrange to have someone drive you home, as a sedative is given during the procedure. Discuss all medications with the pain specialist in advance, as certain blood-thinners, cardiac meds, and blood pressure agents may be held. When you come to the surgical center, a nurse discusses the pros and cons of the procedure, and has you sign a form of informed consent. After you put on the gown, the nurse places an IV catheter in your arm.

What happens with the ESI procedure?

During the procedure, the nurse has you lie face down on the table, and the doctor injects an anesthetic into the skin and deeper tissues. Once the area is numb, the doctor uses x-ray or ultrasound imaging to assure correct needle placement. The needle is positioned near the affected nerve root, and contrast dye is injected. Once in place, the doctor injects the corticosteroid, and sometimes, a long-acting anesthetic.

What can I expect after the ESI procedure?

After the ESI procedure, a nurse monitors your condition for around 30 minutes. Side effects to expect are temporary weakness and numbness of the arm and hand on the affected side. Because of the local anesthetic, the back may be sore, numb, and tender. After discharge, you should rest for the remainder of the day. Return to usual activities as you can tolerate them.

How effective is the epidural steroid injection?

Clinical studies show that many people have a decreased neck and arm pain following the cervical epidural steroid injection procedure. The effects typically last for 6-18 weeks, but can last a shorter duration or a longer duration. Based on studies, the success rates for ESI are around 90%. According to a very recent clinical study, cervical ESI was effective around 70% of the time and is an effective as a procedure. Additionally, radiculopathy is better pain relief.

What medications are used in a cervical ESI procedure?

The ESI involves injection of a long-acting corticosteroid, such as betamethasone and triamcinolone. In addition, a long-acting anesthetic is used, such as bupivacaine or lidocaine. During the procedure, the doctor will administer a mild sedative, such as Versed or Ativan.

Who should have the ESI procedure?

Not everyone is a candidate for the ESI procedure. Patients who benefit from the procedure include anyone with spinal pain, and those who have serious nerve inflammation and radiculopathy. You cannot have the procedure if you have a bleeding disorder, active infection, or if you are pregnant.

What risks are associated with the cervical ESI?

While rare, risks do occur with the ESI. Complications include dural puncture, bleeding, nerve damage, blood vessel injury, and infection. The patient could have an allergic reaction to the medications and solutions used, such as betadine. Side effect to steroids include slight weight gain, swelling, flushing, insomnia, and elevated blood sugar.

Resources

Lutz GE, Vad VB, & Wisneski RJ (1998). Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Archives of Physical Medicine Rehabilitation, 79,1362-1366.

Weinstein SM & Herring SA (2003) NASS. Lumbar epidural steroid injections. Spine Jounral, 3(3 Suppl):37S-44S.

Yoon JY, Kwon JW, Yoon YC, & Lee J (2015). Cervical interlaminar epidural steroid injection for unilateral cervical radiculopathy: comparison of midline and paramedian approaches for efficacy. Korean Journal Radiology, 16(3), 604-612.