What is a cervical epidural?
A cervical epidural steroid injection is an injection that goes into the compartment that houses the spinal cord in your neck. It aims to manage chronic pain caused by irritation and inflammation of the spinal nerves in your neck due to certain conditions or injuries. This type of pain typically radiating from your neck to your shoulders, arms or hands is called cervical radiculopathy. A cervical epidural is not meant to cure neck pain, but rather help provide pain relief and decrease inflammation at the site of the nerve compression that can cause arm / hand symptoms.
During an epidural, your provider injects a steroid into the epidural space around your spinal cord. This epidural space acts as a sleeve and contains things like fat, spinal nerves, blood vessels, and connective tissue. The steroid is meant to reduce swelling and pressure on the irritated nerves, thus helping with the symptoms.
Who needs a cervical epidural?
Cervical epidurals are used to treat a type of pain known as cervical radiculopathy, caused by spinal nerve root inflammation in your neck. The most common symptoms associated with this are pain, numbness / tingling, and sometimes muscle weakness in the upper extremities (arms / hands). Many conditions can irritate your neck spinal nerves, including:
- Cervical herniated disc – often called a ruptured or bulging disc. Over time, the outer layer of the soft, gel-like centers of the disc can dry out, causing it to weaken and crack and travel into locations it doesn’t belong. This may irritate or pinch nearby nerves.
- Cervical degenerative disc disease – occurs when the cushioning between your vertebrae in your neck begins to wear away.
- Cervical spinal stenosis –occurs due the narrowing of one or more spaces within the cervical spine / neck, reducing the amount of available space for spinal nerves to exit the spine and go into the arms. This leads to irritation or pinching of the nerves.
- Cervical osteoarthritis – also known as cervical spondylosis, this involves changes to the bones, discs and joints caused by the normal wear and tear of aging. This can lead to narrowing of the spine, causing inflammation, and pinching of the nerves.
What are benefits of a cervical epidural?
After an evaluation, your provider may recommend a cervical epidural to manage your pain. The seven vertebrae in your cervical spine have several important roles, including:
- Protecting your brain stem.
- Protecting your spinal cord.
- Supporting your skull.
- Allowing you to move your head.
When you experience neck related nerve pain, these functions can be affected. Cervical epidurals most often lead to temporary pain relief that lasts for three months or more, depending on the degree of the underlying disease and how your body responds / heals with the injection. Some people may experience less or no pain relief from the injection.
Successful cervical epidurals can have several positive benefits, including:
- Temporary pain relief.
- Better quality of life and improved ability to do daily activities.
- Reduce or eliminate the need for surgery.
What should I expect during a cervical epidural?
Cervical epidurals are very precise, so your provider will give you specific instructions about what you need to do to prepare. Be sure to tell your healthcare provider if you are pregnant or may be pregnant due to the fluoroscopy imaging usage of dye during the procedure. Your provider may:
- Limit your eating or drinking a certain amount of time prior to the procedure.
- Adjust certain medications.
- Request additional scans as needed.
In most cases, a cervical epidural takes around 15 to 20 minutes. There are different methods in which your provider can access the spinal cord, including:
- Interlaminar – the path of the needle goes between two laminae (a flat bone that is part of each vertebra) in your spine to reach the epidural space.
- Catheter usage – as an additional measure, if the medicine needs to go higher than the site of needle entry, the provider may use a soft wire to thread the medicine higher so it safely and accurately reaches its target location.
Using a fluoroscopy, your provider will guide the needle to the appropriate location in the neck. Local anesthesia will be injected at the skin near the site of needle entry to reduce localized pain. When the needle has reached its target location, contrast dye will be injected to ensure the needle tip is in the right place. Your provider will then slowly inject the medication. This usually includes a mixture of anti-inflammatory medication (steroid) and possibly some additional numbing medicine. Slight pressure, tingling or burning can occur during the procedure is normal, but most pressure sensations resolve within minutes of the procedure. If you feel intense, sharp pain during or after the procedure, tell your provider immediately.
You may experience a temporary increase in pain before the medication begins to kick in during the first 2-5 days, but most steroid injections need a full 7-10 days to take full effect since steroids take a big longer to work. Tenderness and bruising at the site of injection is considered normal and can be alleviate with ice/heat and time based healing.
What are risks of a cervical epidural?
As with any procedure, a cervical epidural carries certain risks and complications. Although rare, they can include:
- Low blood pressure
- Severe headache caused by spinal fluid leakage.
- Infection
- Negative reaction to the medications.
- Bleeding or blood clots.
- Damage to nerves at the injection site.
- Temporary loss of control of bladder or bowels.
While it is very rare, cervical epidurals can have potentially long-term complications, including:
- Permanent neurologic deficit due to spinal cord or nerve damage.
- Chronic pain.
- Permanent paralysis from a hematoma.
Some people experience pain relief for up to 12 months, while others don’t experience pain relief at all. If a cervical epidural doesn’t work for you, your healthcare provider may recommend other forms of treatment for treating your neck / arm pain, and/or possible considering a surgical consultation. It is important to remember that cervical epidurals are not intended to cure your neck pain, but rather help with radiating arm / hand pain or other symptoms that limited upper extremity function.
Contact your healthcare provider immediately if you experience any of the following after your procedure:
- Severe headache while standing or sitting that feels better after lying down.
- Fever
- Reduced or complete loss of bladder or bowel function.
- Numbness or weakness in your legs.