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Cervical Epidural Injection

If you suffer from chronic neck pain that radiates into the shoulders, arms or even hands that has failed to improve with conservative therapy, you may be a candidate for this simple, in-office procedure.

What is a Cervical Epidural Injection?

A cervical epidural injection (aka cervical epidural steroid injection or CESI) is a safe, effective, and minimally invasive treatment for neck pain that has been around for decades. It is a procedure very similar to the epidural a woman will receive to deal with the pain associated with childbirth. With a cervical epidural injection your doctor will place a small amount of anti-inflammatory medication into the epidural space NEAR the spine – not on it or in it.  This will relieve swelling, inflammation but most importantly – PAIN.

Cervical Epidural Injections are an easy and simple method for treating neck pain. Before considering surgery, ask your doctor about this life changing procedure.

Indications

CESI - Cervical Epidural InjectionThe most commonly treated conditions treated with CESI’s are:

  Cervical radiculopathy
  Chronic neck pain
  Headaches
  Spinal stenosis

Cervical radiculopathy is a shooting neck pain that travels into the shoulder(s), arm(s), or even fingers. People will often describe numbness or a pins and needles sensation. This is the result of the spinal cord and or cervical nerve roots becoming compressed – typically from a cervical disc herniation or spondylosis (arthritis of the facet joints). This causes the nerves to become irritated and pain to subsequently radiate down the shoulder or arm (along the path of the affected nerve).

Click Here to Learn More Cervical Radiculopathy

Cervical Nerve Basics

In the cervical spine (the upper spine around the neck) there are eight pairs of spinal nerves. Each pair of nerves provides sensation and function to different 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. C8 exits the spinal canal between the last cervical vertebra (C7) and the first thoracic vertebra (T1).

 

Click Here to Learn More About the Anatomy of the Spinal Cord

More Detail

Cervical Radiculopathy - Cervical Epidural Injection - Cervical Epidural Steroid InjectionEach 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. The physician can use the dermatomal pattern to help diagnose the location of spinal problem based on where the patient reports pain or weakness.

Based on symptoms, medical history, physical and neurological examination, and imaging study findings (X-ray, MRI), the physician determines which spinal nerve root(s) may be generating pain and other symptoms.

What are the Benefits of a Cervical Epidural Injection?

CESIs are simple and relatively painless procedures that have been in use to treat pain since 1986.[1-3] Most physicians consider a cervical epidural injection as the treatment of choice for chronic neck pain and cervical radiculopathy. There is a plethora of evidence that supports its continued use in the treatment of pain. The most important aspect of a CESI is that it is a minimally invasive procedure that can provide rapid pain relief and allow patients to become active again, regaining the ability to resume their normal daily activities.

How Does it Work?

Cervical Epidural Injections serve two purposes:

  1. Reduce inflammation – This serves to calm the symptoms and aid in healing.
  2. Provides important diagnostic information – Based on the results of the injection, your physician will be able to better determine the cause of your pain.

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 the area 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.

 

How Many Treatments Will I Need?

Most patients require between two and three treatments.

When Will I Feel Better?

The positive effects of the injection can occur within two to three days.  Most patients, though, begin to see results after the second injection.

Is a Cervical Epidural Injection Right for Me?

If you are suffering from chronic neck pain that has gone on for more than four weeks, i.e. severe pain that has been refractory to other treatments, contact the Ainsworth Institute of Pain Management today, schedule an appointment with one of our Board Certified Physicians, and see if you could benefit from this highly effective treatment. Early treatment can increase your chances of success and decrease the likelihood of the pain worsening.

Procedure - Patient Details

A Cervical Epidural Injection is typically performed as an outpatient procedure. If necessary, an anesthesiologist can provide mild sedation to help make you comfortable during the procedure. Your physician will sterilize your neck/upper back then numb the skin with local anesthetic . A thin needle is then inserted using Fluoroscopy – a real time X-ray device that will allow your physician to visualize the needle the entire way and make sure it is properly placed inside the epidural space. Once the needle is properly positioned, a small amount of steroid is injected into the epidural space of the spinal canal where the irritated nerve roots are located. Spinal Cord Anatomy v2In some cases an anesthetic, such as Lidocaine or Bupivacaine is added to the steroid to interrupt the pain-spasm cycle and nociceptor transmission. The steroid will spread to the most painful areas of the spine, thus reducing the inflammation and irritation. When the injection is complete, a small bandage covers the injection site.

Cervical epidural injections may require one or more administrations. The entire procedure typically takes 10-15 minutes, but may take longer if several injections are required. When it is over, you will be escorted to a recovery area that is monitored by a nurse or medical assistant. Upon discharge, you will be given written instruction for home care.

Some patients experience discomfort after the procedure for two or three days. This is normal and does not necessarily mean the corticosteroid is not taking effect. This discomfort will typically subside on its own and without any additional intervention.

In advance of the procedure, patients will be asked which medications they take. Certain drugs must be stopped several days before the procedure. In some cases, the physician may ask the patient to cease taking pain and anti-inflammatory medications in order to see how much pain relief can be attributed specifically to the epidural injection.

Our office will typically contact you the day after the procedure for follow up. You may be asked to record your pain levels and other symptoms following the procedure in a “pain diary” in order to assist your physician in fine-tuning future pain treatments.

Risk Factors

Any medical procedure carries with it some inherent risk. CESIs do have risks but they are typically low. It is considered an appropriate non-surgical treatment for patient suffering from neck pain, cervical radiculopathy and headaches. Rare but serious complications include bleeding, infection, nerve injury, headache, and allergic reaction to medication. The medications themselves can also cause complications. For example, the steroids can cause temporary increases in blood sugars, elevated blood pressure, decreased immune response and the potential for weight gain. Other risks include an increase in pain and injection site tenderness – these are typically temporary as well. 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. Your physician will discuss the risks and benefits of this procedure with you.

Evidence of Performance

Stav and colleagues published a study in 1993 on the effectiveness of CESIs on treating chronic neck and arm pain for longer than 6 months. The study showed that 68% of patients treated with CESIs had good to very good relief.[4]  In a study by Castagnera in 1994, 71% of patients receiving a CESI reported at least 75% reduction in pain.[5]  Bush and Hiller reported similar results in 1996.[6] More recently, studies have been published reporting on the efficacy of a series of injections over a single CESI. In 2007, Pasqualucci reported that multiple injections provide better pain relief compared to single injection.[7]  In 2007, Stub and colleagues reported on 161 patients having received CESIs. The study showed that 83% of the injections resulted in pain relief.[8]

 

Cervical epidural injections have provided significant pain relief to many people with moderate to severe chronic neck pain. However, epidural injections are not appropriate for all patients. The amount and duration of pain relief vary from one person to the next. Some have limited relief while others can benefit long-term – there is no way to predict the outcome prior to the injection. Many of the patients who receive CESIs report improved function and decreased pain. Due to the minimal invasiveness of the procedure and the ease with which it can be performed, patients can benefit from additional procedures for prolonged relief.

The Ainsworth Institute is Here to Help

If you are suffering from neck pain and would like to see if you may be a candidate for a cervical epidural injection, contact the Ainsworth Institute of Pain Management today.  Schedule an appointment with one of our Board Certified Physicians to learn more and see if you are a candidate for one of these state of the art treatments.

References

[1] Shulman M: Treatment of neck pain with cervical epidural steroid injection. Reg Anesth. 1986; 11:92-94.

[2] Purkis IE: Cervical epidural steroids. Pain Clin. 1986; 1:3-7.

[3] Rowlingson JC, Kirschenbaum LP: Epidural analgesic techniques in the management of cervical pain. Anesth Analg. 1986; 65:938-942.

[4] Stav A, Ovadia L, Sternberg A, et al.: Cervical epidural steroid injection for cervicobrachialgia. Acta Anaesthesiol Scand. 1994; 37:562-566.

[5] Castagnera L, Maurette P, Pointillart V, et al.: Long term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain. Pain. 1994; 58:239.

[6] Bush K, Hillier S: Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections. a prospective study with independent clinical review Eur Spine J. 1996; 5:319.

[7] Pasqualucci A, Varrassi G, Braschi A, et al. Epidural Local Anesthetic Plus Corticosteroid for the Treatment of Cervical Brachial Radicular Pain: Single Injection Versus Continuous Infusion. Clin J Pain. 2007; 23:551-7.

[8] Strub WM, Brown TA, Ying J, et al.: Translaminar cervical epidural steroid injection. short-term results and factors influencing outcome J Vasc Interv Radiol. 2007; 18:1151-1155.

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