Cervical Epidural Injection: A Comprehensive Guide to Understanding and Exploring the Procedure

A cervical epidural injection involves the targeted delivery of medication, such as a local anesthetic or corticosteroid, into the epidural space surrounding the spinal cord and spinal nerves in the neck region. The epidural space is located between the protective covering of the spinal cord (dura mater) and the vertebral bones.The anterior border of the epidural space consists of the posterior longitudinal ligament. Separately, the posterior border consists of both the lamina and the ligamentum flavum. The ligamentum flavum is loose at the midline in roughly half of the patients, with an absent interspinous ligament. By administering the medication directly to the affected area, the injection aims to reduce inflammation, alleviate pain, and provide long-lasting relief.

Before performing a cervical epidural injection, a healthcare professional will conduct a thorough examination and may order imaging tests, such as X-rays or MRI scans, to identify the source of the pain and determine the most appropriate treatment approach. Once the decision is made to proceed with the injection, the procedure typically follows these steps:

Preparation: The patient lies face down on an examination table, and the area to be treated is cleansed and sterilized.

Numbing the area: A local anesthetic is applied to the skin to minimize discomfort during the injection.

Needle placement: Under fluoroscopy (real-time X-ray guidance), a needle is inserted into the epidural space, usually the C7-T1 interspace, guided by the practitioner’s expertise and imaging.There are different techniques for the procedure; either interlaminar (between the lamina) or transforaminal (through the foramen).[4,5,6]

Contrast dye injection: A contrast dye may be injected to confirm accurate needle placement within the epidural space.

Medication administration: Once the needle is properly positioned, the medication, often a mixture of local anaesthetic and steroid, is slowly injected.

Post-injection monitoring: After the injection, the patient is observed for a short period to ensure there are no immediate adverse reactions or complications.

Cervical epidural injections can offer significant benefits, including:

Pain relief: By reducing inflammation and swelling, the injection can alleviate pain in the neck, shoulders, and upper extremities.

Improved function: Decreased pain and inflammation can restore mobility and improve overall physical function.

Avoidance of surgery: For some patients, cervical epidural injections can provide enough relief to avoid the need for surgical intervention.

Allergic reactions: Some individuals may have an allergic reaction to the injected medications.

While cervical epidural injections are generally considered safe, there are potential risks and side effects associated with the procedure, including:

Temporary increase in pain: Some patients may experience an initial increase in pain before experiencing relief.

Infection: Although rare, there is a risk of infection at the injection site.

Nerve damage: Improper needle placement could potentially damage nerves, resulting in temporary or permanent complications.

After the cervical epidural injection, patients are usually monitored for a short period and then discharged to recover at home. It is common to experience some soreness or discomfort at the injection site for a few days following the procedure. Ice packs and over-the-counter pain relievers may be recommended to manage any post-injection discomfort.

Follow-up  with the healthcare provider are essential to evaluate the effectiveness of the injection and determine the need for further treatments or interventions. Additional injections may be recommended if the desired level of pain relief is not achieved or if the pain returns over time.

Rehabilitation- Patients are expected to follow a structured physiotherapy plan focussing on strengthening of the muscles supporting the cervical spine.

[1]Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population-based study of Rochester, Minnesota, 1976–1990. Brain. 1994;117:325–35. doi: 10.1093/brain/117.2.325. [PubMed] [CrossRef] [Google Scholar]
[2] Kang JD, Georgescu LML, Stefanovic-Racic M, Evans CH. Herniated cervical intervertebral discs spontaneously produce matrix metalloproteinases, nitric oxide, interleukin-6, and prostaglandin E2. Spine. 1995;20:2373–8. doi: 10.1097/00007632-199511001-00001. [PubMed] [CrossRef] [Google Scholar]
[3] Frans RC, saal JS, Saal JA. Human disc phopholipase A2 is inflammatory. Spine. 1992;17:S129–32. [PubMed] [Google Scholar]
[4]Hall ED. Acute effects of intravenous glucocorticoid on cat spinal motor neuron electrical properties. Brain Res. 1982;240:186–90. doi: 10.1016/0006-8993(82)90662-X. [PubMed] [CrossRef] [Google Scholar]
[5] Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand. 1990;34:335–8. doi: 10.1111/j.1399-6576.1990.tb03097.x. [PubMed] [CrossRef] [Google Scholar]
[6] Shoji Y, Kawaguchi Y, Nordborg C, Kikuchi S, et al. Effects of lidocaine on nucleus pulposus-induced nerve root injury: a neurophysiologic and histologic study of the pig cauda equine. Spine. 1998;23:2383–9. doi: 10.1097/00007632-199811150-00004. [PubMed] [CrossRef] [Google Scholar]