Cervical Epidural Injection

Excerpt

Many patients with symptoms of cervical radiculopathy can benefit from a cervical epidural injection. Before one considers a cervical epidural injection, the patient’s pain must persist for at least six to eight weeks, and the patient has to have failed conservative management. Furthermore, patients must not have progressively worsening neurologic deficits.

Cervical radiculopathy affects approximately 83 per 100,000 people per year. Most cases of cervical radiculitis improve with conservative management and do not require a cervical epidural or surgical intervention. Studies are mixed on the efficacy of cervical epidural pain relief, but overall, the injection seems to provide significant pain relief. Patients with chronic recurring neck pain with radicular symptoms can benefit from cervical epidural corticosteroid injections. Significant pain relief is considered 50 percent pain reduction at three months, with 50 percent of patients having significant pain relief after the procedure. The typical injection pattern for cervical corticosteroid injections is following the initial injection; one or two repeat injections can occur two to four weeks later. Radicular symptoms can have multiple etiologies ranging from non-degenerative to diabetes to malignancy. Spondylolisthesis and degenerative disc disease can occur and be a common etiology. Nerve root compression from either cervical spinal stenosis or a herniated disc of the cervical vertebra is the most common cause of cervical radiculopathy. The majority of patients with disc herniation or spondylosis do not require cervical epidural injections. Cervical radiculopathy can lead to chronic neck pain, and intervention is often needed in refractory cases. Overall complications of the procedure include infection, spinal headache, allergic reaction, nerve damage, paralysis, and death. A transforaminal approach to a cervical epidural injection is a more targeted therapy delivery in comparison to an intralaminar technique but has a higher complication rate.