Cervical epidural steroid injections (CESIs) are a frequently used treatment for neck pain and headaches. Acute and Chronic neck pain with or without disc herniation and cervical radiculitis (pain going in to the arm) are the most commonly treated condition with cervical epidural steroid injections. Headaches and cervical spinal stenosis may also benefit from this treatment modality.
Cervical radiculitis results from nerve compression or irritation in the neck that causes radiating pain down the arm with or without numbness and tingling in hand or arm. At times there may be no neck pain but just arm or hand symptoms.
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 cervical epidural steroid injections.
Cervical epidural steroid injections involve injecting a steroid and a numbing medication (a local anesthetic, usually lidocaine and bupivacaine) into the epidural space of the cervical spinal canal where irritated nerve roots are located.
The steroid reduces inflammation and irritation, while the anesthetic interrupts the pain-spasm cycle and nociceptor transmission (Boswell 2007).
The entire procedure usually takes less than 15 minutes. The procedure is done under sterile conditions. It is guided by an X ray machine (fluoroscope). Local anesthetic agent is used to numb the skin to help minimize the pain and discomfort.
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 inter-laminar 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. Researchers 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. Commonly reported post injection issues are slight lightheadedness in a small number of patients. 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 sugar, 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 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 prolonged relief.
If you are experiencing chronic neck pain that has lasted longer than four weeks or is severe you should contact the Minnesota Institute for Pain Management about this highly effective treatment.