Cervical Epidural Steroid Injections
by Nicole Berardoni M.D, Tory McJunkin M.D, and Paul Lynch M.D.
Cervical epidural steroid injections (CESIs) are a frequently used treatment for neck and head chronic pain syndromes. Chronic neck pain and cervical radiculitis are the most commonly treated condition with CESIs. Headaches and cervical spinal stenosis may also benefit from this treatment modality.
Cervical radiculitis results from nerve compression in the neck (cervical spine) that causes radiating pain down an arm. The pain originates from cervical spinal nerves becoming irritated as they exit the spinal cord. The symptoms of cervical radiculitis often include numbness and pain. If a person develops weakness in this distribution it is termed radiculopathy. Cervical radiculitis can be caused by bulging cervical discs or cervical spondylysis, which results from arthritis in the facet joints. Both causes can often be effectively treated with CESIs.
CESIs involve injecting a steroid into the epidural space of the cervical spinal canal where irritated nerve roots are located. The injected medications include both a long-lasting steroid and a local anesthetic (Lidocaine, Bupivacaine).
The steroid reduces inflammation and irritation, while the anesthetic interrupts the pain-spasm cycle and nociceptor
transmission (Boswell 2007). The medicines spread to the most painful levels of the spine, reducing inflammation and
irritation. The entire procedure usually takes less than 15 minutes.
Cervical steroid injections are considered simple and relatively painless. Approximately 72% of patients experienced
immediate pain relief in a 2007 research trial. The trial specifically evaluated the usefulness of a cervical interlaminar
epidural steroid injection in patients with neck pain and cervical radiculopathy (Kwon 2007). If pain relief is only
moderately achieved with the first injection, a series of injections is typically attempted.
The use of multiple injections was studied by the Department of Anesthesiology and Intensive Care at the University of Pavia, Italy and they concluded that therapy with multiple injections provide better control of chronic cervicobrachial pain compared to that with a single injection (Pasqualucci 2007). Therefore, three to six injections yearly may be recommended by your pain specialist to maximize your pain relief.
The most important and greatest success achieved with the use of cervical steroid injections is the rapid relief of
symptoms that allows you to become active again. With this pain relief, you often regain the ability to resume normal daily activities.
Cervical epidural steroid injections do have risks, but they are typically low. This pain treatment is considered an
appropriate non-surgical treatment for many patients who suffer from neck pain and headaches. Complications of the
injection can include bleeding, infection, headaches, and nerve damage. The medications used can also cause
pharmacological complications. These risks include allergic reaction, high blood sugars, decreased immune response,
and the potential for weight gain.
Along with proper technique, the procedural risks are reduced by using fluoroscopic guidance (x-ray) to position the
needle and watch the medication spread during the procedure.
In a 2007 a research study was conducted, in patients with spinal stenosis (narrowing of the spinal canal) associated neck pain. Cervical epidural steroid injections resulted in a 72% effectiveness in relieving neck pain. The study concluded that the use of the injections is a “safe and effective” method in treating patients with cervical neck pain and cervical radiculopathy (Kwon 2007).
The amount and duration of pain relief vary from person to person who receive cervical steroid injections. Some have
limited relief while others can benefit long-term. Many of the patients who receive these injections for management of their chronic neck pain enjoy improved function and diminished pain and can benefit from additional procedures for
If you are experiencing chronic neck pain that has lasted longer than four weeks or is severe you should contact Arizona Pain Specialists about this highly effective treatment. Early intervention may decrease the chances of developing a worsening chronic pain syndrome.
Epidural Local Anesthetic Plus Corticosteroid for the Treatment of Cervical Brachial Radicular Pain: Single Injection Versus Continuous Infusion. Pasqualucci A, Varrassi G, Braschi A, Peduto VA, Brunelli A, Marinangeli F, Gori F, Colò F,
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Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors.
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Kwon JW, Lee JW, Kim SH, Choi JY, Yeom JS, Kim HJ, Kwack KS, Moon SG, Jun WS, Kang HS