Cervical Steroid Injection

Cervical Epidural Steroid Injection

Recent estimates indicate that more than half of adults will experience symptoms of neck or back pain at some point during the course of their lives. For patients with chronic neck pain and cervical radiculitis, the recommended treatment is steroid injections in the cervical region. Many pain specialists prefer cervical steroid injections, as they are quick to perform and have been shown to be effective at reducing chronic and refractory neck and upper back pain.

In many instances, patients will report an almost immediate benefit from the injection in terms of the severity of their pain. Most are expected to resume normal daily activities immediately after the procedure. A meta-analysis was recently conducted on studies examining the effectiveness of cervical steroid injections across the last ten years. The results of this analysis supported the effectiveness of these injections in providing patients with relief from cervical pain.

The precise mechanism of action that accounts for the effectiveness of cervical steroid injections is not fully understood. It is believed that reductions in nerve pain are achieved as the result of the anti-inflammatory effects of the steroids. Steroids have other pain relieving properties as well. This medication has been shown to stabilize irritated nerve membranes and inhibit the conductance of ions. Both these actions have been shown to also aid in the reduction of pain.

Studies examining the long-term benefits of cervical steroid injections are limited and findings from these studies are somewhat varied. While a portion of patients examined in these studies report lasting benefits from receiving cervical steroid injections, others do not. Nonetheless, cervical steroid injections are generally regarded as safe. Thus, patients who do not achieve full symptom relief from just one administration may return for repeat treatments until full symptom relief is achieved.

What is a Cervical Epidural Steroid Injection

How Cervical Epidural Steroid Injection is Performed

The spinal cord is located within the spinal canal and is protected by a padding of cerebrospinal fluid (CSF). The spinal canal is comprised of a tough and durable membrane that also acts as a protective layer for the spinal cord. Just outside the protective membrane of the spinal canal is the epidural space. This space is the target for a cervical steroid injection.

In most instances, only a topical anesthetic is used to numb the surface of the skin where the injection will be performed. However, some patients may request an intravenous medication in order to make the procedure more comfortable.

The performing physician will make two injections. One injection is for the X-ray imaging device that is used to ensure that the physician is placing the injection needle into the appropriate area of the epidural space. In some instances, a contrast dye may be used to confirm the placement of the needle. Contrast dye may also be used to ensure that the medication will be appropriately distributed within the epidural space. After the physician has confirmed that the needle has been placed correctly, the anesthetic medication (i.e., corticosteroid) is injected. The aim of these injections is to administer steroids only to those areas with the most inflammation, so that the patient is not exposed to excessive amounts of the medication.

The procedure for cervical steroid injections does not generally require surgery and can be performed on an outpatient basis. In many instances, the patient does not report any pain associated with the procedure. The majority of patients receiving cervical steroid injections will report almost immediate reductions in their neck and upper back pain following the procedure. Studies examining the use of multiple injections to treat cervical pain have provided support for the benefit of repeat treatment for patients whose pain did not fully remit following initial treatment.

As with many other medical treatments, cervical steroid injections are associated with some risk, though they are generally mild and rare. Commonly reported side effects following the procedure include:

Bleeding (more common among patients with bleeding disorders)
Infection
Nerve damage following direct trauma from the injection needle
Dural puncture as the result of improper placement of the injection needle
Spinal cord injury (e.g., cord edema, cord syrinx, scarring, fluid within the cord)

Conditions Related to Cervical Epidural Steroid Injection

Cervical steroid injections are commonly used to treat a condition known as cervical radiculitis. This condition is caused by excessive pressure placed on the nerves located within the cervical, or neck, region. This compression can cause the nerves to become irritated, which is believed to be the source of pain and discomfort within the area. In many instances, patients will report the sensation that the pain radiates down the arm. Further, patients may also report weakness and numbing sensations along with the pain.

Cervical steroid injections can be used for many other conditions involving neuropathic pain within the neck and upper back region. Such pain can be caused by compression placed on the cervical nerves as the result of inflammation within the area, excessive fluid retention, or a herniated or bulging intervertebral disc.

Conclusions

Cervical steroid injections are a highly effective treatment option for managing moderate to severe neuropathic pain within the cervical area. Many pain specialists prefer this procedure, as it is relatively quick and can be performed on an outpatient basis. Steroid medications are used for this procedure primarily because of their anti-inflammatory properties.

A portion of patients receiving cervical steroid injections will report an almost immediate benefit from the injections. For patients who do not experience a full reduction in pain from the initial treatment, repeat injections may be warranted. Studies examining the effectiveness of these injections have provided ample support for their use in treating neuropathic cervical pain. Results from long-term follow-up studies remain mixed. Individuals are encouraged to speak with their doctor about the risks and benefits associated with cervical spinal injections.

References

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