Cervical Epidural Steroid Injection for Neck & Arm Pain

Cervical Epidural Steroid Injection for Neck & Arm Pain

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What is the epidural space?

The dura is a protective covering of the spinal cord and nerves.  The area surrounding the dura is the epidural space.  In the neck, this space is called the cervical epidural space.

What causes pain in the epidural space? 

The cervical area of the spine has seven bones, called vertebrae.  Soft discs between the vertebrae act as cushions, offering support and help to control motion.  If a disc tears or herniates, chemicals may leak out causing inflammation of the nerve roots or the dura and pain.  Bone spurs stemming from arthritis can also press against nerve roots and cause inflammation and pain.

What is a cervical epidural steroid injection? 

During this procedure an anesthetic and a steroid are injected into the epidural space to reduce inflammation.  There are various approaches to the epidural space in order to place the medication as close to the inflammation as possible.

What is a lumbar epidural steroid injection? 

Your doctor can determine the cause of your pain.  If you have pain in the neck with pain radiation down the arm, you may have a herniated disc that is pinching and irritating a nerve root.  A cervical epidural steroid injection can decrease the inflammation around the nerve, disc and dura and significantly improve pain and function.  Most often, the disc will heal itself with time.  The injection serves to facilitate improvement in pain and function.

What happens during an injection? 

The procedure may or may not be done with intravenous sedation to help you relax.  If you are very anxious, you may want to request sedation by talking to your doctor prior to the day of the procedure.  Sedation will require that you fast for four hours prior to the procedure.  If you will not be having sedation, we recommend that you eat a normal meal prior to the procedure.  A local anesthetic will be used to numb the skin.  The doctor will then insert a thin needle directly into the epidural space.  If at any point in time the procedure becomes painful, you should let the doctor know as he can use more anesthetic to numb the painful area.  Fluoroscopy, a type of x-ray, will be used to ensure the safe and proper position of the needle.  A dye will also be injected to make sure the medicine will go into the correct spot.  Once the needle is in the correct location, an anesthetic and a steroid will be injected.

What happens after an injection?

You will be monitored for approximately 30 minutes after the procedure.  Before you leave the clinic, you will be given discharge instructions.  Please keep track of your pain as this will help your doctor determine the next step in treatment.  It is normal to feel better immediately after the procedure.  This is the effect of the anesthetic.  It will most likely wear off a few hours after the procedure.  This is normal.  It may be caused by needle irritation or by the steroid itself.  Steroids normally take two to three days to begin working, but can take as long as one week.  You should be able to return to work the day after the procedure.

How long can I expect pain relief?

Depending on the amount of inflammation, an injection can offer several months of pain relief.  For some people, one injection can provide long-term pain relief.  Depending on your response to the first injection, your doctor will determine if a second injection is necessary.