The cervical spine is the part of the spine located in your neck. The spinal cord sits inside a tunnel created by the vertebrae (bones making up the spine). It is also protected by a soft layer of tissue called the dura. The epidural space is the area between the bony canal and the dura layer of the spinal cord.
An epidural injection is a procedure to deliver medication into this epidural space. The medication may include an anesthetic that will numb the pain and a steroid that can decrease swelling and irritation.
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Reasons for Procedure
An epidural injection may be done if you have pain in your neck and upper limb that is not responding to conservative treatment, such as oral medications and physical therapy.
Damage to local joints or discs of the spine can irritate the nerves exiting the spinal cord. This can cause inflammation around the nerves, which leads to pain. The pain may be in the neck or may travel down to the shoulders and arms, and even to the hands and fingers.
The injection may provide relief for a few weeks or even a couple months depending on the exact cause of pain.
This procedure may help manage the pain until the injury that caused the nerve irritation has time to heal.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Increase in pain
- Bleeding or fluid leakage in spinal canal
- Spinal headaches
- Nerve damage
- Allergic reaction to the medication used, such as hives, lightheadedness, low blood pressure, or wheezing
If you smoke, talk to your doctor about ways to quit. Smoking can weaken your immune system and slow healing.
Your doctor may not want to do this injection if you have:
- Had success with conservative treatment
- Not tried other conservative treatment
- Allergies to the local anesthetic, x-ray contrast, or medications being used
- Local skin or other infection
- Bleeding disorder or take blood-thinning medication
- Uncontrolled high blood pressure or diabetes
- Unstable angina or heart failure
What to Expect
Prior to Procedure
Your doctor may begin with conservative treatment, such as rest, medication, physical therapy, and exercise.
Before the procedure you may need:
- A physical exam
- Imaging tests to evaluate the spinal structures with x-rays or an MRI scan
- To discuss allergies that you may have to the anesthetic, pain medication, or latex
In addition, talk to your doctor about your medications. You may have to stop taking some medications up to one week or more before the procedure.
Additional considerations include:
- Your doctor may ask you to avoid food or drink a few hours before the procedure.
- You will need someone to drive you home after the procedure.
You will be awake during this procedure. A local anesthetic will be used to numb the skin before the injection. Your doctor may also give you medication to help you relax.
Description of Procedure
You may have devices attached to help monitor your blood pressure, heart, and oxygen levels. You will be asked to lie on your stomach or side on an x-ray table or sit in a chair. The skin around the injection site will be cleansed. A local anesthetic will be given to numb the area.
The doctor will inject a contrast dye. This dye will help highlight the area to guide the needle. This is done using a type of x-ray called fluoroscopy. Next, when the doctor has reached the epidural space, the steroid will be delivered.
Immediately After Procedure
A small bandage will be placed over the injection site. You may be able to go home after being observed.
How Long Will It Take?
The injection only takes a few minutes. The entire procedure may be 30-60 minutes.
How Much Will It Hurt?
There is local discomfort as the numbing medication first goes in. But the rest of the procedure should not be painful. Once the injected anesthetic wears off, you may have some discomfort.
At the Care Center
Your doctor will assess your level of pain relief.
You will have to reduce your activity level for the first day or so. You can apply ice to the affected area to relieve swelling and discomfort. Pain can be managed with medications. Proper care of the insertion site can help prevent infection. You can slowly increase your activity as tolerated or by your doctor's instructions, but injected steroids may take time to work. If you have diabetes, monitor your blood sugar levels more carefully a few weeks after an injection. The medication that was injected may cause elevated blood sugar levels.
Call Your Doctor
Call your doctor if any of these occur:
- Severe pain or headache
- Fever or chills
- Increased arm weakness or numbness
- Problems swallowing
- Redness, swelling, increasing pain, bleeding, or discharge from the injection site
If you think you have an emergency, call for emergency medical services right away.
American Chronic Pain Association
Ortho Info—American Academy of Orthopaedic Surgeons
Cervical epidural. University of Wisconsin School of Medicine and Public Health Department of Radiology website. Available at: https://www.radiology.wisc.edu/sections/msk/interventional/Cervical%20epidural/index.php. Updated December 18, 2017. Accessed December 19, 2017.
Cervical radicular pain and radiculopathy. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116531/Cervical-radicular-pain-and-radiculopathy. Updated September 5, 2016. Accessed December 19, 2017.
Cervical radiculopathy: Non-operative treatments and cervical epidural steroid injection. Hospital for Special Surgery website. Available at: https://www.hss.edu/conditions_cervical-radiculopathy-nonoperative-treatments-epidural.asp#.VJMhbtLF-So. Accessed December 19, 2017.
Epidural steroid injection. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T901362/Epidural-steroid-injection. Updated September 5, 2016. Accessed December 19, 2017.
Epidermal injections. Radiology Info—Radiological Society of North America website. Available at: https://www.radiologyinfo.org/en/info.cfm?pg=epidural. Updated February 17, 2017. Accessed December 19, 2017.
Last reviewed November 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP Last Updated: 12/20/2014