40 Burton Hills Blvd., Suite 500
Nashville, TN 37215
ph: 615.234.5900
fx: 615.234.7994
Interventional Pain Management: Cervical Epidural Injection
A cervical epidural injection is a safe and effective minimally invasive treatment. This type of spinal injection services two purposes: (1) reduces nerve inflammation, calms symptoms, aids healing and, (2) provides important diagnostic information.
The procedure involves injecting a corticosteroid into the epidural space. A corticosteroid is a powerful, slow-releasing, and long-lasting anti-inflammatory medication effective in reducing inflammation. Sometimes a narcotic is also injected to increase pain relief. The epidural space is between the protective membrane (dura mater) covering the spinal cord and the bony spinal canal. After the medication is injected, it flows and coats the nerve roots.
Diagnostically, when the patient’s symptoms are relieved, the injection provides evidence that a particular nerve root is a pain generator.
There are many spinal problems that can cause nerve irritation in the neck. As depicted in the illustration, a herniated disc or bone spurs (osteophytes) can compress fragile spinal nerve roots.
Basics about Cervical Spinal Nerves
In the cervical spine there is 8 pair of spinal nerves. Each pair of nerves provides sensation and function to parts of the body. Just as the levels of the cervical spine are abbreviated, the spinal nerve pairs are numbered in a corresponding way. C1 is the area between the skull and first cervical vertebra (also abbreviated C1). C8 exits the spinal canal between the last cervical vertebra (C7) and the first thoracic vertebra (T1).
Each pair of nerve roots exit the spinal column and branch out into the body forming the peripheral (outer) nervous system. These nerves innervate the upper part of the body and enable movement (motor function) and feeling (sensory function). The illustration depicts this pattern called dermatomes. Your doctor uses the dermatomal pattern to help diagnose the location of your spinal problem based on where you have pain or weakness.
From your symptoms, medical history, physical and neurological examination, and imaging study findings (X-ray, MRI), your doctor determines which spinal nerve root(s) may be generating pain and other symptoms.
Patient Procedure Preparation
Well in advance of your procedure appointment, our medical team provides you with instructions specific to you and medications you regularly take.
If you take blood thinning medication such as Coumadin or Plavix, please notify our medical team. Certain drugs must be stopped several days before your procedure.
Our medical team may ask you to stop pain and anti-inflammatory drugs before the procedure to accurately measure the amount of relief you obtain from the injection.
Possible Risks and Complications
Any medical procedure poses a risk or possible complication. Although extremely rare, possible risks or complications include bleeding, infection, nerve injury, headache, and allergic reaction to medication. More common is an increase in pain, injection site tenderness, and steroid side effects.
What to Expect: The Procedure and After
The environment and preparation is similar to outpatient surgery. You change into a hospital gown and rest in bed. Medications to relax you are given intravenously (IV) and you are moved into the procedure suite. Then you are seated in a chair or positioned in bed in such a way to stabilize your head and neck. Next, the skin area is cleaned with a sterile soap. A local anesthetic is injected and given time to numb your skin and spine muscles.
Using fluoroscopy (real time x-ray), the doctor places the needle and injects a small amount of contrast (dye) to make sure the needle is in proper position. Next, an anesthetic and corticosteroid is injected into the epidural space. Sometimes, pain is temporarily increased during the injection. However, our medical team is dedicated to making you as comfortable as possible. A small Band-Aid® covers the injection site.
Depending on the number of spinal levels injected, the entire procedure is over in about 15 minutes. Afterward, you are moved into the recovery area and monitored until our medical team deems you ready for release.
Before you are released home, our medical team provides you with written home care instructions. Some patients experience 2 to 3 days of discomfort after the procedure. This is normal and does not necessarily mean the corticosteroid is not taking effect.
Conclusion
A member of our medical team will telephone you the morning after your cervical epidural injection to follow-up. We recommend you keep a daily journal of your pain level and other symptoms following your procedure. This helps you to provide your doctor with detailed information about your treatment progress.
