Cervical Epidural Steroid Injections
Content
- Cervical Epidural Steroid Injections
- What is a Cervical Epidural Steroid Injection?
- Who is a Suitable Candidate for Cervical Epidural Steroid Injections?
- How Does a Cervical Epidural Steroid Injection Work?
- What Happens During the Cervical Epidural Steroid Injection Procedure?
- Before the Procedure
- During the Procedure
- What to Expect After a Cervical Epidural Steroid Injection
- Are Cervical Epidural Steroid Injections Safe?
- How Long Does Pain Relief Last?
- Orthopaedic Doctor for Cervical Epidural Steroid Injections
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What is a Cervical Epidural Steroid Injection?
A cervical epidural steroid injection (ESI) is a non surgical pain management treatment that involves injecting a medication (in this case, corticosteroids) directly into the cervical epidural space at the back of your neck. This epidural space is the fat-filled area surrounding the spinal nerve roots, but very rarely around the spinal cord. Cervical ESIs are generally used to treat irritation and inflammation of the spinal nerve roots, which may be caused by certain medical conditions.
A cervical ESI may also include a local anaesthetic to ensure your comfort during the procedure, along with the steroid medication to treat your ongoing symptoms. The effects may last for several weeks or months, and follow-up injections may be required for continued symptom relief.
Who is a Suitable Candidate for Cervical Epidural Steroid Injections?
You may be considered a candidate for a cervical ESI if you experience symptoms indicating a pinched nerve root, such as radiating pain, numbness, tingling, or a burning sensation. If you are receiving conservative medical care to treat such symptoms by a spine specialist in Singapore, you may also be suitable for our cervical ESI.
How Does a Cervical Epidural Steroid Injection Work?
Cervical ESIs would be administered to treat the following conditions:
- Cervical radiculopathy
- Cervical herniated disc
- Cervical spinal stenosis
- Degenerative disc disease
- Osteoarthritis/cervical spondylosis
The cervical epidural space is contained within the cervical spine (which supports your head and protects the spinal cord) and the spinal cord (the nerves that allow the brain to communicate with the rest of the body). Nerve roots can become inflamed or injured due to certain medical conditions, leading to pain that radiates to your shoulder blades or arms, along with other symptoms.
A cervical ESI is delivered into the cervical epidural space, where the medication will surround the irritated nerve roots that are causing pain and other symptoms. The medication will usually take some time to take effect, but it may provide temporary relief of pain and other symptoms. However, these effects and their durations may vary from person to person.
What Happens During the Cervical Epidural Steroid Injection Procedure?
A cervical ESI typically occurs in a clinic or hospital and may take several minutes to complete.
Before the Procedure
During the initial consultation, your doctor will need to assess your health and medical history to determine if you are eligible for a cervical ESI. If you are, they will brief you on what to expect from the procedure, including possible risks and side effects, and answer any questions or concerns you may have. Please note that you may not be suitable for a cervical ESI if you have:
- Previously received a steroid injection in the past three months, or four steroid injections within the last year.
- A scheduled vaccination is soon, or one was received recently.
- An active infection.
- Blood clotting issues or other health conditions.
You may also need to abide by your doctor’s instructions to prepare for the injection::
- Fast for at least six hours (or as indicated by the doctor) before the procedure. You can and should continue to stay hydrated with clear water.
- Avoid taking blood thinners or similar medications until your doctor says you may resume your medication schedule.
- Arrange for transportation to and from the clinic or hospital. Avoid driving on your own, as the anaesthesia can make you feel sleepy.
- Take a bath or shower before the procedure, but avoid using lotions, perfumes, deodorants, or nail polish.
Your doctor may also perform an MRI or CT scan to examine the cervical epidural area to identify a suitable injection site, ensuring the medication is delivered accurately and without complications.
During the Procedure
On the appointed day for the injection, you will be asked to sit down or lie on your stomach. You may be given a sedative to keep you relaxed during the procedure. Your doctor will then clean the injection site around your neck using an antiseptic solution while preparing sterile sheets around the area. They may also inject local anaesthesia near the injection site to numb the discomfort when you receive the injection, as the ESI typically uses a larger needle.
The injection may be performed via one of two delivery methods:
- Interlaminar ESI: Your doctor may inject steroids between two laminae (the bony plates on each vertebra that protect the spinal cord) to reach the epidural space.
- Transforaminal ESI: This injection goes through the foramina, the openings that allow nerve roots to exit the spinal cord. It is not often used to prevent accidental vascular damage.
Once the cervical ESI is prepared, the doctor will use prior imaging scans, X-ray guidance, and contrast dye (or any combination) to administer the medication at the injection site. Once the injection is confirmed safe to proceed, the doctor will slowly inject the steroid into the epidural space so that the medication can reach the targeted inflamed nerves.
Immediately after the injection, your doctor applies pressure to the injection site to prevent bleeding, then cleans the area one more time before applying a medical dressing. You will then be asked to take a short rest while the medical team monitors you for any changes or reactions to the medication before you are discharged.
What to Expect After a Cervical Epidural Steroid Injection
Not long after the injection, you may feel some discomfort and numbness around the injection site, but this should subside over time. While you may also not exhibit any pain or discomfort at first due to the local anaesthesia, the pain and discomfort may return as the anaesthetic’s effects wear off. These should also gradually subside as the steroids begin to take effect within a few days. Your doctor may prescribe painkillers to manage this pain and discomfort.
If you have received sedation or local anaesthesia before or during the procedure, avoid driving, drinking alcohol, operating machinery, or signing important legal documents for the next 48 hours. Ensure someone is at home to help with various tasks so you can focus on resting and recovering.
It is essential that you rest sufficiently and balance it with light physical activity to maintain your physical health. Slowly increase your activity levels as your physical condition improves, but avoid placing too much strain on your neck. Take time to recover, as it can help prevent further injury to the cervical spine or nerve roots.
Be sure to attend follow-up appointments with your doctor, so they can monitor your progress and adjust your treatment plan as needed. If necessary, follow-up cervical ESIs may be scheduled to maintain consistent symptom relief.
Are Cervical Epidural Steroid Injections Safe?
When conducted by a properly trained and qualified doctor, a cervical ESI is safe to administer. With any medical procedure, however, there are still potential risks, side effects, and complications, including:
- Steroid flush, featuring noticeable facial or chest flushing with warmth and increasing temperature over a few days.
- Low blood pressure.
- Severe headaches.
- Nausea.
- Potential bleeding in the epidural space.
- Infection.
- Unexpected weight gain. (rare if the injection is only done once)
- Sleeping difficulties.
- Nerve damage.
- Allergic reactions.
- Stroke risk due to a vascular puncture.
In most cases, doctors will limit how often you can receive a cervical ESI, as there is also a risk of musculoskeletal weakness with each ESI you receive.
How Long Does Pain Relief Last?
Pain and symptom relief from a cervical ESI may last several days, weeks, or even months. However, there are also instances where a cervical ESI does not provide any pain or symptom relief. A detailed medical consultation will typically provide sufficient information for a doctor to determine if you are a suitable candidate to receive a cervical ESI.
It is also important to speak to your doctor regularly to update them on your recovery progress, allowing them to adjust your recovery plan as needed and recommend additional treatments if necessary. Contact Avant Orthopaedics today to learn more about how we can support your general recovery.
Orthopaedic Doctor for Cervical Epidural Steroid Injection
Dr. Hope Ang
MBBS (NUS) | MMed (Anaes) | FAMS
Dr Hope Ang is a Consultant Anaesthesiologist with extensive expertise in acute and chronic pain management, dedicated to helping patients regain function, reduce suffering, and improve quality of life through evidence-based, personalised care.
With more than 18 years of clinical experience, Dr Ang specialises in the assessment and treatment of complex chronic pain conditions, including musculoskeletal pain, neuropathic pain, cancer-related pain, and persistent postoperative pain. His approach integrates interventional pain procedures, ultrasound-guided regional techniques, multimodal pharmacological strategies, and close collaboration with multidisciplinary care teams to address both the physical and functional impact of chronic pain.
Dr. Razmi
FAMS (Ortho) | M Med (Gen Surg) (SG) | FRCSEd (Gen Surg) | MBBS (SG)
Dr. Razmi, a practicing orthopaedic and spine consultant at Mount Elizabeth Novena Hospital.
Dr Razmi routinely performs discectomy (minimally invasive surgery), decompression surgery, spinal fusion, motion preservation surgery including dynamic stabilization and dynamic fusion technologies and lumbar and cervical disc replacements. He is the first surgeon in Singapore to perform stand-alone anterior approached spine fusion using the Synfix implant.
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Frequently Asked Questions
Is a cervical epidural steroid injection a permanent treatment?
No, it is primarily meant to provide short-term pain and symptom management for cervical spine-related conditions that cause pain, inflammation, and other symptoms. Follow-up cervical ESIs may be needed to provide consistent symptom relief, but other, more permanent treatment methods may also be considered, if necessary.
How soon can I return to normal activity levels after a cervical epidural steroid injection?
It may take a few days before you can resume normal activities, but it is essential to minimise strain on your neck to allow the steroids to continue providing symptom relief. For example, you should have someone to drive you around to avoid stressing your neck while driving. Speak to your doctor for further advice.
What steroids are used in a cervical epidural steroid injection?
The type of steroid used will typically depend on the severity of your condition, the injection site’s location, and the choice of injection approach (interlaminar or transforaminal). You can speak to your doctor for further clarification.
