Cervical Epidural Injection
Information about your procedure:
The intervertebral disc is the structure between the vertebrae (bones of the spine). It acts as both a spacer and a shock absorber. Imaging techniques, such as an MRI scan, can reveal small disc bulges and/or wear and tear in the spine with possible nerve irritation or inflammation.
The epidural space surrounds the dura. The dura is the sac around the nerve roots that contains cerebrospinal fluid and spinal cord and nerves. The nerves in the neck travel through the cervical epidural space before extending down through the shoulders and into the arms and hands. Nerve irritation can therefore cause pain from the shoulders down to the hands.
Although most people’s pain will settle in time without the need for surgery, in the short term, delivery of anti-inflammatory medicine direct to the source of irritation around the spinal nerve roots is beneficial and can provide excellent pain relief and help your surgeon understand your condition. In a cervical epidural injection, the aim is to deliver the medication around the cervical nerves roots, which are often involved in neck pain and symptoms in the arms such as pain and altered sensation.
About the procedure
The procedure is carried out under intravenous sedation and with the patient lying on their stomach. The skin on the back of the neck is cleaned with antiseptic solution. Live X-ray and contrast (which is a kind of dye that the x-ray can visualise) are used as guidance to direct the needle to the cervical epidural space before a small volume of corticosteroid and / or local anaesthetic is injected.
Once the numbness has worn off often the pain returns, occasionally slightly worse, until the corticosteroid takes effect. This can take several days. Continue to take your usual pain relief medication until you begin to feel the benefit of the corticosteroid.
It is important not to stop taking certain pain relief medication suddenly. It may be necessary to gradually ‘wean’ yourself off them – your GP can advise you if necessary.
Risks and complications
Fortunately, there are very few risks associated with cervical epidural injections. These include infection, nerve or dural injury (the membrane around the nerves), bleeding (please inform your surgeon if you take any blood-thinning medications) and temporary numbness or weakness to your arms and hands. Very rarely (< 1%), there have been reports of spinal cord injury following a cervical epidural injection, something that may lead to long-term arm and leg weakness and numbness of varying degrees
What to expect in hospital
Immediately after the injection you will be taken on your bed to the recovery ward where nurses will monitor your blood pressure and pulse. Oxygen may be given to you through a facemask to help you wake up after the sedation. Once back on the ward and when you are fully awake you will be allowed to get out of bed (taking care if some numbness or heaviness persists).
You will normally be allowed home a few hours after your injection, when you and your nurse are happy with your mobility. Please arrange for either a friend or relative to collect you from the hospital, as driving yourself or taking public transport is not advised for 48 hours after the sedation. A responsible adult should remain with you overnight.
In general, you may return to work on the next day if this is sedentary and provided that you are comfortable.
We will provide a sick note at your request on the day of the procedure, if necessary.
Normally between 4 to 6 weeks