Cervical Epidural Steroid Injections
Cervical Epidural Steroid Injections
Cervical epidural steroid injections (CESIs) are a common and effective treatment for neck pain, arm pain, and other symptoms caused by nerve irritation or inflammation. This guide will help you understand how CESIs work, their benefits, potential risks, and what to expect during the procedure.
What Are Cervical Epidural Steroid Injections?
Cervical epidural steroid injections involve the injection of corticosteroids into the epidural space of the cervical spine, which is the area surrounding the spinal cord where nerve roots exit. This space contains fat and small blood vessels that cushion the nerves. The corticosteroid medication works by reducing inflammation and swelling around the irritated or compressed spinal nerves. This reduction helps relieve pain, numbness, and tingling sensations that often radiate from the neck down to the arms. Additionally, CESIs can improve mobility and function, allowing patients to engage more comfortably in daily activities and physical therapy. The effects can be both immediate, due to the local anesthetic used, and long-term, thanks to the anti-inflammatory properties of the steroid.

Conditions Treated with Cervical Epidural Steroid Injections
CESIs are often used to manage pain from:
Herniated cervical discs:
When a disc bulges or ruptures, it can press on nearby nerves, causing irritation and inflammation. This pressure can lead to a variety of symptoms, including neck pain, stiffness, and headaches, as well as radiating pain, numbness, tingling, or weakness in the shoulders, arms, and hands. The severity of symptoms often depends on the extent of the herniation and the specific nerve roots affected. Herniated cervical discs typically occur due to age-related degeneration, trauma, or repetitive strain. In some cases, the herniation can compress the spinal cord, leading to more serious neurological issues such as difficulty with coordination, balance, or fine motor skills. Cervical epidural steroid injections can be an effective treatment option to reduce inflammation and alleviate the associated pain.
Cervical spinal stenosis:
Cervical spinal stenosis refers to the narrowing of the spinal canal in the neck, which compresses the spinal cord and nerve roots. This condition can be caused by age-related degenerative changes, such as thickened ligaments, bone spurs, or herniated discs, which reduce the space available for the nerves. Symptoms of cervical spinal stenosis can vary, ranging from mild neck pain and stiffness to more severe issues like numbness, tingling, weakness in the arms and hands, and even problems with balance and coordination. In advanced cases, it can lead to myelopathy, a condition where spinal cord compression affects motor skills and bladder or bowel control. Cervical epidural steroid injections can help alleviate symptoms by reducing inflammation around the compressed nerves, providing significant pain relief and improving function. However, in cases of severe stenosis with progressive neurological deficits, surgical intervention may be necessary to relieve the pressure on the spinal cord.
Degenerative disc disease:
Age-related changes that cause neck and arm pain.
Cervical radiculopathy:
Cervical radiculopathy occurs when a nerve in the neck becomes compressed or irritated, leading to pain, numbness, tingling, or weakness that radiates into the shoulder, arm, or hand. This condition is often caused by herniated discs, bone spurs, or degenerative changes in the cervical spine that put pressure on the nerve roots. Symptoms can vary depending on the affected nerve but commonly include sharp or burning pain, muscle weakness, and reduced reflexes. Cervical epidural steroid injections can provide targeted relief by reducing inflammation around the affected nerve, alleviating symptoms, and improving overall function.
How Do Cervical Epidural Steroid Injections Work?
The corticosteroid medication reduces inflammation around irritated nerves by suppressing the immune response that causes swelling and irritation. It does this by inhibiting the production of inflammatory chemicals, such as prostaglandins and cytokines, which play a key role in promoting inflammation. Corticosteroids also decrease the permeability of capillaries, reducing fluid leakage into tissues and limiting swelling. This combined action helps to minimize the pressure on nerves and alleviates the associated pain and discomfort. This reduction in inflammation helps decrease pain, swelling, and numbness, especially in cases of nerve compression or irritation due to conditions like herniated discs or spinal stenosis. Some patients may begin to feel relief within a few hours after the injection, thanks to the local anesthetic. However, the full effect of the corticosteroid may take a few days to a week to become noticeable, as it works to reduce inflammation more gradually. By reducing pressure on the affected nerves, CESIs can improve nerve function, lessen discomfort, and promote healing. While CESIs primarily manage symptoms by reducing inflammation and alleviating pain, this reduction in inflammation can indirectly support the body’s natural healing processes. By decreasing nerve irritation and allowing for improved blood flow and reduced mechanical stress, CESIs create a more favorable environment for tissues to recover. This can help prevent further damage and promote the gradual restoration of nerve function and structural stability in the cervical spine. However, it’s important to note that CESIs do not cure the underlying condition but serve as an important part of a comprehensive treatment plan, often combined with physical therapy and other interventions. Additionally, the procedure includes a local anesthetic, which provides immediate, short-term relief by temporarily numbing the affected area and interrupting pain signals to the brain. The effects of the local anesthetic typically last for a few hours, providing temporary comfort while the corticosteroid begins to take effect. This combination of anti-inflammatory and anesthetic effects allows for rapid symptom relief within hours and longer-term improvement over days to weeks.
Approaches to Cervical Epidural Steroid Injections
There are two primary approaches to injecting the epidural space:
Interlaminar Approach:
This method involves inserting the needle between the laminae (bony structures) of the cervical vertebrae. The medication is delivered into the central epidural space, which allows the steroid to spread more broadly around the affected nerves. This approach is commonly used for diffuse or widespread symptoms.
While generally considered safe, the interlaminar approach carries specific risks. These include a higher chance of accidental dural puncture, which can lead to a spinal headache. There’s also a risk of the steroid spreading less precisely compared to the transforaminal approach, potentially resulting in less targeted relief. Additionally, because the injection is closer to the spinal cord, there’s a slightly increased risk of direct spinal cord injury, though this is extremely rare. Bleeding and infection, while uncommon, are potential complications that require careful procedural technique to minimize.
Transforaminal Approach:
In this technique, the needle is guided through the neural foramen, where the nerve root exits the spinal canal. The medication is placed closer to the inflamed nerve, providing targeted relief. This approach is particularly useful for unilateral radicular pain or when a specific nerve root is affected.
While the transforaminal approach allows for more targeted delivery of medication, it carries specific risks compared to the interlaminar approach. There is a higher risk of injury to blood vessels, which could lead to serious complications like spinal cord infarction or stroke if the steroid inadvertently enters an artery. Additionally, because the needle is positioned closer to the nerve root, there’s a greater chance of direct nerve irritation or damage, which may cause temporary or, in rare cases, permanent nerve issues. This approach also carries a slightly increased risk of bleeding in the foramen, which can compress the nerve root. Despite these risks, the transforaminal approach remains effective and safe when performed by experienced practitioners using imaging guidance.

The Procedure: What to Expect
Preparation: You will lie face down on an X-ray table. The skin is cleaned, and a local anesthetic is applied.
Needle Placement: Using fluoroscopy (live X-ray), the doctor guides a thin needle into the epidural space.
Injection: A contrast dye ensures proper needle placement before the steroid and anesthetic are injected.
Recovery: You’ll be monitored for 15-30 minutes after the procedure.
Benefits of Cervical Epidural Steroid Injections
Pain relief
Cervical epidural steroid injections offer significant reduction in neck and arm pain by targeting the underlying inflammation causing nerve irritation. This targeted approach can provide both immediate relief, due to the local anesthetic, and longer-lasting effects from the corticosteroid. Many patients experience a dramatic decrease in pain levels, which can improve quality of life and enable better participation in physical therapy and daily activities. While the extent of relief varies from person to person, CESIs are particularly effective for conditions like herniated discs, spinal stenosis, and cervical radiculopathy. In some cases, the relief can last for several weeks or even months, reducing the need for additional treatments or medications.
Improved mobility
Cervical epidural steroid injections can significantly enhance the ability to perform daily activities by reducing pain and inflammation. When neck and arm pain are lessened, patients often experience increased range of motion and flexibility. This improvement enables more comfortable participation in routine tasks such as driving, working, and engaging in hobbies. Additionally, reduced pain can make physical therapy more effective, which further supports long-term mobility gains. Over time, consistent pain relief can help patients regain strength, coordination, and confidence in their movements, contributing to an overall better quality of life.
Reduced need for surgery
Cervical epidural steroid injections help manage symptoms effectively, reducing the need for invasive surgical procedures. By targeting the root cause of neck and arm pain—inflammation around the spinal nerves—CESIs can provide significant relief, allowing many patients to avoid or delay surgery. This is especially beneficial for individuals who are not ideal candidates for surgery due to underlying health conditions or those seeking to minimize recovery time and potential surgical risks. While not a permanent cure, CESIs can significantly improve quality of life and functionality, offering a non-surgical option for managing chronic pain.
Quick recovery
Cervical epidural steroid injections offer quick recovery with minimal downtime compared to surgical options. Most patients can resume their normal activities within a day or two, depending on individual response. Unlike surgery, which requires weeks or even months of recovery, CESIs allow patients to benefit from pain relief without extensive rehabilitation. This rapid recovery is particularly advantageous for individuals with busy schedules or those who wish to avoid the risks and prolonged downtime associated with surgical procedures. Additionally, the minimally invasive nature of the procedure reduces the likelihood of complications, promoting faster healing and improved overall outcomes.
Risks and Side Effects
While CESIs are generally safe, potential risks include:
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Infection
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Bleeding
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Nerve damage
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Headache
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Temporary increase in pain
Who Should Avoid CESIs?
CESIs may not be suitable if you have:
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Active infections
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Bleeding disorders
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Uncontrolled diabetes
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Allergies to contrast dye or steroids
Frequently Asked Questions
How long does the pain relief last? Relief can last from weeks to months, depending on the individual.
How many injections can I have? Typically, up to three injections per year are recommended.
Is the procedure painful? Discomfort is minimal, thanks to local anesthetics.
Conclusion
Cervical epidural steroid injections are a valuable treatment for neck and arm pain caused by nerve irritation. They offer significant pain relief with minimal risks. If you’re struggling with chronic neck pain, CESIs might be the right solution for you.
For expert care, contact Red Butte Pain Solutions at 602-633-4334 or Schedule Now.
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