Before resorting to surgery, a popular treatment option that many with chronic spine pain use are cortisone epidural injections. Although epidural injections are known for relieving labor pains, they are also used in different parts of the spine for pain. The corticosteroid medicine is used for easing pressure and inflammation in the nerve roots surrounding the damaged disc in the spine.
Those that are experiencing pain, numbness, or tingling in their neck, shoulders, or down their arm could benefit from a cervical epidural injection. Starting right below your skull, your cervical spine comprises the first seven bones in the spine and differ greatly from the other vertebrae in the back. While the neck is a very delicate part of the body, it is also one of the strongest allowing a wide range of motion. Cervical epidurals are a common treatment option for three different cervical spine conditions before resorting to surgery. These three conditions include cervical radiculopathy, cervical disc herniation, and cervical spondylosis.
Cervical Radiculopathy. Known as a pinched nerve in the neck, cervical radiculopathy is the inflammation of a nerve in the neck area that is exiting the spine. The pain associated with the pinched nerve occurs mostly in the neck, but can also be present in the shoulders or down the arm.
Cervical Disc Herniation. A herniated disc is a very common spine condition that can leave you with excruciating pain or no symptoms at all, depending on the severity. In most cases, a cervical herniated disc can stem from a previous neck injury or other trauma.
Cervical Spondylosis. Found in people middle-aged and older, cervical spondylosis is the normal wear-and-tear of discs and cartilage in the neck. In most cases, surgery is not recommended for treating cervical spondylosis so an epidural injection could be an option to treat this condition.
During the Procedure
Before the cervical epidural procedure begins, you may be given an IV sedation to help relax before the procedure begins. First the back of the neck is prepped with a sterile soap, then a local anesthetic is used at the injection site for extra comfort during the procedure. Once the anesthetic has enough time take effect, it is finally time for the corticosteroid cervical epidural injection.
While either sitting up in a chair, or laying on your side or stomach, your doctor will use a live X-ray to pinpoint where the needle needs to be place in the cervical spine. There are two different approaches to injecting the steroid medication for a cervical epidural: interlaminar and transforaminal.
The interlaminar approach injects the steroid through the back of the spine between two vertebra. This epidural injection approach can only be used between discs in the lower cervical spine because of the available space in the spinal canal. As the central canal narrows towards the top of the spine, the transforaminal epidural approach is delivered through the side of the spine and is directly injected in a smaller area where a nerve root exits the spine.
Using a syringe to enter your neck, your physician will reach the membrane just outside of the spinal cord. A contrast dye is then used to ensure where the medication itself will be injected. Finally, the steroid medication is injected and the syringe is removed.
Once cleared for release by your doctor, it is best to avoid any strenuous activities for the first day. You will likely feel pain relief after the procedure because of the anesthetic used before the cervical epidural. After the numbing wears off, it is common to experience soreness around the site of the injection for up to three days after the procedure. To help ease this discomfort, you can use an ice pack, warm wash cloth or over the counter pain medication.
It takes 3 to 5 days to feel the effects of the steroid injection, so it’s important to be patient before assuming that the procedure did not work. The steroid takes two weeks to fully work and patients can notice the pain relief from the injection for up to six months. Depending on the diagnosis and recommendation from your doctor, you may need multiple steroid injections over the duration of a couple weeks. Sometimes patients will receive three cervical epidural injections, two weeks apart.
Side Effects and Risks
While most side effects and risks are low for this common procedure, it is important to keep track of your pain and symptoms post-procedure. The most common side effects from this cervical spine procedure include headache, bleeding, and nerve damage. Other side effects from the steroid medication itself include temporary water retention and weight gain. For patients with diabetes, it is important to monitor blood sugar levels closely as steroids can increase glucose levels.
A possible risk for any kind of epidural injection, especially in the cervical spine is the chance of a dural puncture. Also called a wet tap, a dural puncture happens when the epidural syringe unintentionally pierces the protective membrane that surrounds the spinal cord. The puncture triggers fluids in the brain and spinal cord to leak, causing spinal headaches. If after the procedure you experience painful headaches, a fever, or a tingling feeling in the legs or arms you need to be seen by a professional immediately. Receiving an epidural injection for spinal stenosis is a low risk procedure that almost half of all patients notice pain relief, however it is always important to monitor your side effects.