Cervical radiculopathy is a condition that can cause discomfort stemming from the neck and extending into the arms. It arises when a nerve in the neck region becomes irritated or compressed, leading to a range of symptoms. Epidural steroid injections are a frequently employed non-surgical approach to address the pain associated with this condition.
Understanding Cervical Radiculopathy
Cervical radiculopathy occurs when a nerve root in the cervical spine, or neck, is compressed or irritated. The cervical spine consists of seven small vertebrae that begin at the base of the skull, and nerve roots branch out through openings in these vertebrae. Damage or compression to these nerve roots can lead to pain and other sensations along the nerve’s pathway.
Common symptoms include pain that radiates from the neck into the shoulder, arm, or hand, often affecting just one side of the body. Patients may also experience sensory issues such as numbness or tingling in the fingers or hands, or motor problems like muscle weakness, lack of coordination, or reduced reflexes in the arms. The pain can be described as burning or sharp, and it may worsen with neck movement or straining.
This condition frequently develops from issues such as herniated discs or bone spurs, also known as cervical spondylosis. A herniated disc occurs when the inner material of a cervical disc leaks out and presses on adjacent nerves, being a common cause in younger individuals, often due to injury or stress on the spine. Bone spurs, or osteoarthritic changes, and thickening ligaments can narrow the spinal canal and pinch nerves, which is more common in older patients as discs degenerate with age.
The Epidural Steroid Injection Procedure
An epidural steroid injection is a medical procedure designed to deliver anti-inflammatory medication directly into the epidural space of the spine in the neck region. This space surrounds the spinal cord and contains spinal nerves, fat, and blood vessels. The primary purpose of injecting corticosteroids, which are strong anti-inflammatory medications, into this area is to reduce inflammation around the compressed nerve roots. Sometimes, a local anesthetic is also included to provide immediate pain relief.
The procedure usually takes about 15 to 30 minutes. Patients are generally positioned face-down on an X-ray table, and pillows may be used for optimal alignment. The skin in the neck area is thoroughly cleaned with an antiseptic solution, and a sterile drape is placed to maintain a clean field. A local anesthetic is then injected into the skin to numb the area, minimizing discomfort during the needle insertion.
Precision is achieved through the use of imaging guidance, such as fluoroscopy, which is a type of live X-ray. The physician uses this real-time imaging to carefully guide a thin needle into the epidural space. A small amount of contrast dye may be injected first to confirm the correct needle placement and ensure the medication will spread properly around the targeted nerve roots. Once the needle’s position is verified, the corticosteroid medication, sometimes mixed with an anesthetic, is slowly injected. Patients may feel increased pressure or a cold sensation during this injection, which is considered normal.
Effectiveness and Outcomes
Patients can expect a varied timeline for experiencing pain relief and functional improvement. Relief is not immediate, as the corticosteroids typically require a few days to a week to begin their anti-inflammatory effects. Some individuals may experience temporary immediate relief from the local anesthetic if it is included, but this typically wears off within a few hours, and pain may even temporarily increase for a day or two due to needle irritation or the steroid itself.
The duration of pain relief following an injection varies significantly among individuals, ranging from several days to several months or potentially longer. For instance, one study indicated that some patients experienced pain relief for 12 to 24 months after cervical interlaminar epidural steroid injections. Success rates, often defined as at least 50% pain relief, have been reported to be around 40% to 84% in various studies. A 2020 review noted that approximately 50% of people achieved at least 50% pain relief from cervical transforaminal epidural steroid injections.
Many patients may require more than one injection to achieve sustained relief, though most providers typically limit injections to two to three per year. It is important to understand that these injections aim to manage symptoms by reducing inflammation and alleviating nerve pressure rather than curing the underlying cause of cervical radiculopathy. The pain relief provided often allows patients to engage more effectively in other conservative treatments, such as physical therapy, which can help strengthen the spine and improve overall function. This integrated approach can help prolong the benefits of the injection and address the root issues contributing to the discomfort.
Potential Side Effects and Safety Considerations
While cervical epidural steroid injections are generally considered safe, patients should be aware of potential side effects and safety considerations. Common, usually mild, side effects can include temporary soreness or bruising at the injection site. Some individuals may experience a “steroid flush,” characterized by warmth and flushing of the face and chest, which can last for several days. Other transient effects might involve lightheadedness, headaches, temporary increase in blood pressure or blood sugar, restlessness, or difficulty sleeping. Occasionally, pain may temporarily increase for a few days after the procedure before the steroids take effect.
Less common but more serious risks are possible, though rare. These include infection at the injection site or within the epidural space, such as an epidural abscess or meningitis. Bleeding, which could lead to an epidural hematoma, is another rare risk. Nerve damage or spinal cord injury, while extremely uncommon, has been reported and could potentially result in new neurological deficits, including temporary or, in very rare cases, permanent weakness or paralysis. Allergic reactions to the injected medications are also a possibility.
Patients should seek immediate medical attention if they experience a fever of 100.5° F (38.5° C) or higher, pain that worsens significantly after 48 hours, new or worsening numbness or weakness in their arms or legs, or any new loss of bowel or bladder control. Redness, swelling, or leakage at the injection site also warrant prompt medical evaluation. The injection may not be recommended for individuals with active infections, bleeding disorders, or those taking blood-thinning medications, which may need to be temporarily stopped or adjusted under medical supervision.