Cervical Epidural Steroid Injection

What is a cervical epidural injection?

A cervical epidural injection is a shot of medicine in your neck. The injection goes into the area around the spinal cord in your neck.

This injection is to help with pain, tingling, or numbness in your neck, shoulder, or arm.

This injection may include a steroid, which reduces swelling and pain, and a local anesthetic, which numbs the nerves. Or it may only have a steroid.

Some people get a series of these injections over weeks or months before they achieves pain relief.

How is a cervical epidural done?

We will use a tiny needle to numb the skin where you are getting the injection.

After the skin is numb, we will use a larger needle for the epidural injection. We will use fluoroscopy (live X-ray) to help guide the needle. You may feel some pressure. But you should not feel pain.

It takes about 10 to 15 minutes to get this injection. You will need someone to drive you home.

What can you expect after a cervical epidural?

If the injection did not include local anesthetic, you may not feel anything different other than the soreness in the muscle.

If your injection included local anesthetic medicine, your neck, shoulder, arm, or hand may feel heavy or numb right after the shot.

With a local anesthetic, your pain may be gone right away. But it may return after a few hours. This is because the steroid hasn’t started working yet. Before the steroid starts to work, your neck, shoulder, or arm may be sore for a few days.

These injections don’t always work. When they do, it takes 1 to 7 days. The pain relief can last for several days to a few months or longer.

Some people are dizzy or feel sick to their stomach after getting this injection. These symptoms usually don’t last very long.

You may also be able to return to your daily routine right away if you do not feel much side effects.

If your pain is better, you may be able to keep doing your normal activities or physical therapy. If your pain is only a little better or if it comes back, you may get another injection in a few weeks. If your pain has not changed, talk to your doctor about other treatment choices. We will usually schedule a follow up visit soon after the injection to evaluate how well you responded to the injection to decide on the next step.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments and call us if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

Figure 1. Positioning of C7-T1 interlaminar epidural steroid injection. For all cervical epidural steroid injections, C7-T1 interlaminar approach is used regardless of the level of the pathology. The steroid will diffuse to the intended area of concern via the epidural space.

Figure 2: AP view of the cervical epidural steroid injection.

Figure 3. Contralateral oblique view of the cervical epidural steroid injection.

Cervical epidural steroid injection: this is used to treat cervical radiculopathy, or pain that radiates from the neck to the arms. It is usually caused by pinched nerves as they exits the spinal column. The steroid calms down the inflammation and relieves the arm pain. The neck pain may not be alleviated if there is concomitant facet joint-mediated pain, which is really common. The technique described here is the C7-T1 interlaminar, right paramedian approach. The black color is the contrast and it outlines the epidural space surrounding the dural sac/CSF/spinal cord. You can see the C7-T1 foramen as the C8 nerve root exits. Characteristic circular contrast voids, which is due to epidural fat, are also seen.