Project Description

Dr. Nick Scott performs Cervical Steroid Injection. Watch this video to see a Cervical Steroid Injection performed live.

Pain Doctor Nick Scott Performs Cervical Steroid Injection.

Previous studies have suggested that between half and 80% of all adults will experience some form of neck or back pain at some point during their lifetime. In particular, patients reporting chronic neck pain or even neck radiculitis are considered ideal candidates for receiving treatment in the form of cervical steroid injections. In fact, many pain specialists prefer cervical steroid injections for treating neuropathic pain of the neck and upper back, because the procedure is relatively quick and most patients respond well.

For many of the patients receiving cervical steroid injections, almost immediate reductions in pain severity are reported following the procedure. Indeed, most are expected to return to their normal daily activities right after receiving the injection. A recent meta-analysis examined the findings from studies across the last ten years and found ample support for the effectiveness of cervical steroid injections.

Though the precise mechanism of action is not fully understood, it is generally believed that the anti-inflammatory action of the steroid medication is what accounts for the effectiveness of this procedure. Steroids, though, are known to have other properties that make them effective pain relievers as well. More specifically, steroids can stabilize an irritated nerve membrane, which thereby leads to reductions in pain. Additionally, steroid medications can inhibit the conductance of ions, which can lead to decreased pain sensation.

Previous studies exploring long-term follow-up of cervical steroid injections are limited. Further, findings from those few studies that do exist remain mixed. Some report that patients experience long-term pain-relieving benefits following cervical steroid injections, while others do not. In general, however, these injections are regarded as safe and may be used on a repeat basis. For instance, patients who do not achieve full symptom relief from the initial injection may return for several follow-up treatments over the course of a year.

How Is A Cervical Steroid Injection Performed?

The spinal canal is comprised of a durable membrane whose function is to protect the spinal cord inside. Within the spinal canal is an additional protective layer of cerebrospinal fluid (CSF) that acts as a cushion for the spinal cord. The epidural space is the area that falls just outside of the protective spinal canal. This is where the cervical steroid injection is placed.

To perform this procedure, most physicians only use a topical anesthetic. In some instances, the patient may request that an intravenous medication also be used. This will aid in making the patient more comfortable during the procedure.

The physician will use an imaging device to ensure that the injection needle is placed properly within the epidural space. A contrast dye may also be employed. Contrast dye can serve two functions: to ensure that the needle has been placed properly within the epidural space and also to ensure that the medication will be appropriately distributed within the space.

Once the performing physician has ensured that the location of the injection needle is correct and that appropriate distribution of the solution will be achieved, then the corticosteroid medication is injected. The primary goal of these injections is to achieve appropriate distribution of the medication in the areas of the most inflammation, reducing any unnecessary exposure to the steroids.

Cervical steroid injections are a minimally invasive procedure and are performed on an outpatient basis. Patients tend to report little to no pain associated with the procedure itself and will experience an almost immediate effect. For those patients who have not achieved full symptom relief, repeat injections may be warranted. Previous studies examining the effectiveness of these repeat injections have provided some support for their benefit on symptoms.

There are some risks involved with cervical steroid injections. These risks are relatively rare and mild in severity. Possible side effects associated with cervical steroid injections include:

  • Direct trauma to the nerve tissue from the injection needle, resulting in nerve damage
  • Bleeding (common among bleeding disorder patients)
  • Infection
  • Dural puncture from the injection needle
  • Injury to the spinal cord (including cord syrinx, cord edema, fluid within the cord, or scarring)

Conditions Related To Cervical Steroid Injections

Patients suffering from cervical radiculitis are commonly referred to receive cervical steroid injections. Cervical radiculitis generally occurs as the result of compression placed upon the nerve fibers within the neck, or cervical, region. Excessive pressure placed on the nerves can lead to irritation of the nerve tissue and pain. Given that the cervical nerves extend outward through the arm from the spinal cord, it is not uncommon for patients to report that their pain and discomfort radiates down the arm. In addition to this pain, cervical radiculitis patients may also report numbing sensations and weakness in the area.

In addition to cervical radiculitis, most neuropathic pain conditions affecting the neck and upper back region can be treated using cervical steroid injections. These conditions can arise as the result of excessive pressure placed on the cervical nerves due to excessive fluid retention, swelling of the surrounding tissue, and even herniated or bulging intervertebral discs.

Conclusion

Cervical steroid injections are an effective, non-surgical option for treating neuropathic pain arising within the cervical region. This procedure is widely used as it is easy to perform and many patients report almost immediate relief from cervical pain.

Cervical steroid injections are regarded as relatively safe to perform. Thus, individuals who do not achieve full symptom relief after the initial treatment may return for additional injections. Risks associated with cervical steroid injections are generally rare and mild in severity. Patients are urged to speak with their physician about the risks and benefits associated with this treatment.

References

  1. Bicket MC, Gupta A, Brown CH, Cohen SP. Epidural injections for spinal pain: A systematic review and meta-analysis evaluating the “control” injections in randomized controlled trials. 2013; 119(4):907-31.
  2. Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. American Society of Interventional Pain Physicians. Pain Physician. 2007;10(1):7-111.
  3. Kwon JW, Lee JW, Kim SH, Choi JY, Yeom JS, Kim HJ, Kwack KS, Moon SG, Jun WS, Kang HS. Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors. Skeletal Radiol. 2007;36(5):431-6.
  4. Huston CW. Cervical epidural steroid injections in the management of cervical radiculitis: Interlaminar versus transforaminal. A review. Curr Rev Musculoskelet Med. 2009;2(1):30-42.
  5. Manchikanti L, Cash KA, Pampati V, Wargo BW, Malla Y. A randomized, double-blind, active control trial of fluoroscopic cervical interlaminar epidural injections in chronic pain of cervical disc herniation: Results of a 2-year follow-up. Pain Physician. 2013;16(5):465-78.
  6. Pasqualucci A, Varrassi G, Braschi A, Peduto VA, Brunelli A, Marinangeli F, Gori F, Colò F, Paladini A, Mojoli F. Epidural Local Anesthetic Plus Corticosteroid for the Treatment of Cervical Brachial Radicular Pain: Single Injection Versus Continuous Infusion. Clin J Pain. 2007;23(7):551-7.
  7. Scanlon CG, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections: More dangerous than we think? Spine. 2007;32(11):1249-1256.