A cervical epidural injection (CEI) is a common, minimally invasive procedure used to treat pain originating from the neck and upper extremities. This treatment involves the precise delivery of medication into the epidural space, a small area that surrounds the spinal cord and the exiting nerve roots in the cervical spine. The primary goal of a CEI is to reduce inflammation and irritation of the spinal nerves, which are often the source of chronic pain. The injection aims to provide pain relief and improve function without the need for more invasive surgery.
Conditions Treated by the Injection
Physicians recommend a cervical epidural injection when a patient’s neck pain is caused by nerve irritation and has not responded adequately to conservative treatments like physical therapy or oral medications. A primary indication for this procedure is cervical radiculopathy, often described as a “pinched nerve,” where symptoms like pain, numbness, tingling, or weakness radiate from the neck down into the shoulder, arm, or hand.
The irritation causing these symptoms can be due to structural issues within the cervical spine. Common causes include a herniated disc, where the soft inner material bulges out and presses on a nearby nerve. Another indication is cervical stenosis, a narrowing of the spinal canal or the nerve root openings, which puts pressure on the spinal cord or nerves. The injection targets the inflammation resulting from these mechanical compressions, offering temporary relief to allow the nerve time to heal.
The Procedure Explained
The cervical epidural injection is performed under sterile conditions, typically in an outpatient setting, with the patient positioned face down or sometimes sitting up. Before the injection, a local anesthetic is administered to numb the skin and underlying tissue at the insertion site, minimizing discomfort. The procedure uses fluoroscopy, a specialized form of real-time X-ray guidance.
Fluoroscopy allows the physician to visualize the needle’s trajectory and confirm its placement within the epidural space, ensuring accurate and safe delivery near the affected nerve root. Once the needle is positioned, a small amount of contrast dye is injected. This dye is visible on the X-ray and spreads throughout the epidural space, confirming the needle tip is not in a blood vessel or the spinal fluid sac.
After the position is confirmed, the therapeutic medication is injected, usually a combination of a corticosteroid and an anesthetic agent. The corticosteroid is a potent anti-inflammatory drug that reduces the swelling and irritation of the nerve roots. The anesthetic agent provides immediate, though temporary, pain relief by blocking nerve signals, which helps confirm that the target nerve was the source of the pain. The entire procedure generally takes between five and fifteen minutes.
Immediate Aftercare and Potential Complications
Following the injection, the patient is moved to a recovery area and monitored for 15 to 30 minutes to ensure there are no immediate adverse reactions. Patients must have someone drive them home due to the temporary effects of the local anesthetic or light sedation, which can cause dizziness or drowsiness. For the first day, patients are advised to take it easy, limiting activity and avoiding heavy lifting or strenuous exercise.
Common, minor side effects are short-lived and may include temporary soreness at the injection site, which can be managed with ice. Since the procedure involves a local anesthetic, patients may experience transient numbness or heaviness in the neck, shoulder, or arm, which resolves within a few hours. In some cases, a temporary increase in pain may occur for a few days before the steroid begins to take effect, a phenomenon sometimes called a “steroid flare.”
Though rare, serious complications include infection, bleeding, or nerve injury. A severe headache, known as a dural puncture headache, can occur if the needle accidentally punctures the sac containing spinal fluid. Patients must seek immediate medical attention if they develop signs of infection, such as fever or increased redness and discharge at the injection site. They should also seek care if they experience new or worsening symptoms like persistent numbness, weakness, or loss of bladder control.