A cervical injection is a minimally invasive medical procedure used to diagnose and manage chronic discomfort that originates in the neck, which is the cervical region of the spine. This intervention involves the precise delivery of medication directly to a specific source of pain, such as an inflamed nerve root or a painful joint. The primary goal is to reduce inflammation and temporarily block pain signals, offering patients significant relief when conservative treatments like physical therapy or oral medications have been ineffective. The procedure is typically performed in an outpatient setting, allowing for a targeted approach that minimizes systemic side effects.
Defining the Types of Cervical Injections
Cervical injections are categorized based on their distinct anatomical targets within the neck, serving either a therapeutic or diagnostic purpose.
A Cervical Epidural Steroid Injection (CESI) targets the epidural space surrounding the spinal cord and nerve roots. The medication, typically a mixture of a corticosteroid and a local anesthetic, is delivered here to reduce the swelling and irritation of spinal nerves caused by a herniated disc or spinal stenosis. This condition is known as cervical radiculopathy.
A Cervical Facet Joint Injection focuses on the small joints located on the back of the vertebrae. These joints can become painful due to arthritis or mechanical stress. Injecting them directly with an anesthetic and steroid mixture can relieve pain and confirm if the facet joint is the source of the discomfort.
The third procedure is the Cervical Medial Branch Block, which is primarily a diagnostic tool rather than a long-term treatment. This injection targets the small medial branch nerves that transmit pain signals exclusively from the facet joints. By temporarily numbing these nerves with an anesthetic, a physician can definitively confirm if the facet joint is generating the pain, helping to guide future treatments like radiofrequency ablation.
Preparing for the Procedure
Preparation for a cervical injection often begins days before the scheduled appointment with a thorough review of the patient’s medications. Physicians commonly instruct patients to stop taking blood-thinning medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), for a period ranging from three to seven days prior to the procedure. This precaution minimizes the risk of bleeding at the injection site.
Specific instructions regarding eating and drinking must also be followed, especially if sedation is planned, often requiring a fasting period of two to eight hours. Patients must arrange for an adult to drive them home afterward, as the effects of any sedation or the temporary numbness from the local anesthetic make driving unsafe. Patients should discuss all allergies and pre-existing health conditions with their physician, and wear loose, comfortable clothing without metal zippers or jewelry that could interfere with the X-ray equipment.
The Injection Process
The injection procedure is performed in a sterile environment and typically takes less than 30 minutes from start to finish. The patient is usually positioned lying on their stomach on the procedure table, and the skin over the injection site is thoroughly cleaned with an antiseptic solution. A local anesthetic is then administered with a small needle to numb the skin and the underlying tissue, minimizing any discomfort from the larger injection needle.
Precision is achieved through fluoroscopy, which is a form of real-time X-ray guidance. The physician uses this live imaging to carefully advance the injection needle to the exact target location. Once the needle is confirmed to be in the correct position, a small amount of contrast dye is injected to ensure the medication will flow properly and to confirm that the needle tip has not entered a blood vessel.
After confirming safe placement, the therapeutic mixture, usually consisting of a steroid for inflammation reduction and an anesthetic for immediate pain relief, is slowly injected. Patients may feel a sense of pressure or fullness during this step, but significant pain is uncommon. Immediately following the injection, some patients may experience temporary numbness or heaviness in the arm or hand due to the local anesthetic, which is an expected effect.
Immediate Post-Procedure Care and Results
Following the injection, patients are moved to a recovery area for a brief observation period, typically lasting 15 to 60 minutes, where medical staff monitor for any immediate reactions. Activity restrictions are necessary for the first 24 hours, including avoiding strenuous activity, heavy lifting, and driving. Mild soreness or tenderness at the needle insertion site is common and can be managed with a cold pack.
The initial pain relief experienced immediately after the procedure is due to the local anesthetic, but this effect wears off within a few hours. The underlying pain may return briefly until the steroid component begins to work, which typically occurs within two to seven days. The duration of relief varies widely among individuals, lasting from several weeks to many months. Patients should contact their physician immediately if they develop a fever, severe headache, new-onset weakness, or numbness that lasts longer than a few hours, as these symptoms require immediate medical attention.