A cervical injection is a common, non-surgical treatment used to manage persistent pain originating from the neck (cervical spine) that often radiates into the upper extremities. This procedure involves the precise delivery of medication, typically a combination of a local anesthetic and a corticosteroid, into specific areas to address inflammation or irritation of spinal nerves and joints. The goal is to reduce pain, improve function, and allow a patient to progress with physical therapy and rehabilitation efforts. This minimally invasive approach provides an alternative when conservative treatments like oral medication have not provided adequate relief.
Understanding the Cervical Spine Anatomy
The cervical spine, or neck region, is composed of seven stacked bones (C1 through C7) that protect the spinal cord and support the head’s movement. Intervertebral discs between the vertebrae act as shock absorbers and allow for flexibility. Small paired facet joints at the back of the vertebrae facilitate the neck’s forward, backward, and twisting motions.
The spinal cord runs through the central spinal canal. At each level, a pair of spinal nerves branches off, exiting through small openings called foramina. These nerve roots control sensation and movement in the neck, shoulders, arms, and hands. Pain radiating down the arm (radiculopathy) typically results from compression or inflammation of these nerve roots due to a herniated disc or spinal stenosis. Localized neck pain, often worsened by movement, frequently stems from inflammation or arthritis within the facet joints.
The Different Categories of Cervical Injections
Cervical injections are categorized based on the pain source they treat and the specific anatomical location of medication delivery. The three primary types address either nerve root inflammation or pain originating from the facet joints.
Cervical Epidural Steroid Injection (CESI)
A CESI is designed to treat nerve root inflammation (radiculopathy), which causes pain that travels down the arm. The medication is delivered into the epidural space, the area surrounding the spinal cord and nerve roots. This procedure targets inflammation often caused by a herniated disc or spinal stenosis that pinches the nerve root.
Cervical Facet Joint Injection
This injection targets pain originating directly from the small facet joints located on the back of the vertebrae. This joint pain is associated with arthritis or mechanical stress, leading to localized neck discomfort. A mixture of anesthetic and steroid is injected directly into the joint capsule, serving both as a diagnostic tool and a therapeutic treatment.
Cervical Medial Branch Block (MBB)
An MBB is primarily a diagnostic procedure used to confirm if the facet joints are the source of a patient’s pain. The medial branch nerves transmit pain signals from the facet joints to the brain. The physician injects a local anesthetic near these nerves to temporarily block the pain signal. Significant temporary relief strongly indicates the facet joint is the pain generator, suggesting that a longer-lasting treatment, such as radiofrequency ablation, may be beneficial.
Preparing for and Receiving the Injection
Preparation focuses on patient safety. Patients are instructed not to eat or drink for several hours before the appointment and must temporarily stop taking certain medications, especially blood thinners, to minimize bleeding risk. Since the procedure may involve light sedation and cause temporary numbness, arranging for a responsible adult to drive the patient home is mandatory.
The injection is usually performed in an outpatient facility, with the patient positioned face-down. The neck area is cleansed, and a local anesthetic is administered to numb the skin. A distinguishing feature of the procedure is the use of real-time X-ray guidance, known as fluoroscopy, which is necessary for precise needle placement.
The physician uses fluoroscopy images to guide a thin needle to the exact anatomical target, often confirming the position with a small injection of contrast dye before delivering the medication. The entire process typically takes 15 to 30 minutes. Afterward, patients are moved to a recovery area for a brief observation period to monitor for immediate side effects.
How the Medication Provides Pain Relief
The injected medication is usually a combination of two agents, each serving a distinct purpose. The local anesthetic, such as lidocaine or bupivacaine, works almost immediately by temporarily numbing the targeted nerve or joint. This component offers rapid, though short-lived, relief and is often used diagnostically to confirm the exact source of pain.
The corticosteroid, an anti-inflammatory medication, provides the longer-lasting therapeutic benefit. The corticosteroid coats the irritated nerve roots or joint surfaces, reducing the swelling and inflammation that cause pain signals. Unlike the anesthetic, the steroid does not provide instant relief; it often takes two to seven days to become fully effective as inflammation subsides.
The extent and duration of pain relief vary among individuals, commonly lasting for several weeks to many months. These injections are not a permanent cure but are intended to break the cycle of pain and inflammation, allowing patients to participate more effectively in physical therapy and conservative care.