Definition

The cervical spine is the part of the spine in your neck. The spinal cord sits inside a tunnel created by the vertebrae (bones making up the spine). It is also protected by a soft layer of tissue called the dura. The epidural space is the area between the boney canal and the dura layer of the spinal cord.

An epidural injection is a procedure to deliver medicine into this epidural space. The medicine may include an anesthetic that will numb the pain and a steroid that can decrease swelling and irritation.

Reasons for Procedure

An epidural injection may be done if you have pain in your neck and upper limb that is not responding to conservative treatment, such as oral medicines and physical therapy.

Damage to local joints or discs of the spine can irritate the nerves exiting the spinal cord. This can cause inflammation around the nerves, which leads to pain. The pain may be in the neck or may travel down to the shoulders and arms, and even to the hands and fingers.

The injection may provide relief for a few weeks or even a couple months depending on the exact cause of pain.

This procedure may help manage the pain until the injury that caused the nerve irritation has time to heal.

Possible Complications

Potential problems are rare. But, all procedures have some risk. Your doctor will review potential problems, like:

• Increase in pain
• Bleeding or fluid leakage in spinal canal
• Infection
• Spinal headaches
• Nerve damage
• Allergic reaction to the medicine used (eg, hives, light-headedness, low blood pressure, wheezing)

Smoking may increase your risk of complications.

Your doctor may not want to do this injection if you have:

• Not tried other conservative treatment
• Had success with conservative treatment
• Allergies to the local anesthetic, x-ray contrast, or medicines being used
• Local skin infection
• An infection (eg, flu )
• Bleeding disorder or take blood-thinning medicine
• Pain that is due to infection or malignancy
• Uncontrolled high blood pressure or diabetes
• Unstable angina or congestive heart failure

Talk to your doctor about these risks before the procedure.

What to Expect

Prior to Procedure

Your doctor may begin with conservative treatment, such as rest, medicine, physical therapy, and exercise.

Before the procedure, your doctor may:

• Do a physical exam and ask you about your medical history
• Have tests done (eg, x-ray , MRI scan )
• Ask you about any allergies that you may have to the anesthetic, pain medicine, or latex

In addition, talk to your doctor about your medicines. You may have to stop taking some medicines up to one week or more before the procedure, like:

• Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen)
• Blood-thinning drugs, such as warfarin
• Anti-platelet drugs, such as clopidogrel

Additional considerations include:

• Your doctor may ask you to avoid food or drink a few hours before the procedure.
• You will need someone to drive you home after the procedure.

Anesthesia

You will be awake during this procedure. A local anesthetic will be used to numb the skin before the injection. Your doctor may also give you medicine to help you relax.

Description of Procedure

You may have devices attached to help monitor your blood pressure, heart, and oxygen levels. You will be asked to lie on your stomach or side on an x-ray table or sit in a chair. The skin around the injection site will be cleansed. A local anesthetic will be given to numb the area.

The doctor will inject a contrast dye. This dye will help highlight the area to guide the needle. This is done using a type of x-ray called fluoroscopy. Next, when the doctor has reached the epidural space, the steroid will be delivered.

Immediately After Procedure

The nurse will place a small bandage over the injection site. You may be able to go home after being observed by the nurses.

How Long Will It Take?

The injection only takes a few minutes. The entire procedure may be 30-60 minutes.

How Much Will It Hurt?

There is local discomfort as the numbing medicine first goes in. But the rest of the procedure should not be painful. Once the injected anesthetic wears off, you may have some discomfort.

Post-procedure Care

1. At the Care Center:

Your doctor will assess your level of pain relief.

2. At Home:

When you return home, take these steps:

• Do not exert yourself on the first day. Talk to your doctor about any specific activity recommendations.
• To reduce soreness, apply ice or a cold pack to the affected area for 15-20 minutes, a few times over the first day. Wrap the ice in a towel. Do not apply it directly to your skin.
• Take over-the-counter pain medicine as recommended by your doctor. The soreness should go away in a couple of days. Pain may return, though, when the anesthetic wears off. It may take a few days before the steroid medicine takes full effect.
• Follow your doctor’s instructions on cleaning the injection site.
• Avoid baths, pools, or whirlpools for 48 hours after the injection. It is usually safe to shower, though.
• Ask your doctor when you should return to work.
• If you have stopped any medicines before the procedure, ask your doctor when you can resume taking these again.
• Be sure to follow your doctor’s instructions.

If you have diabetes, monitor your blood sugar levels more carefully a few weeks after an injection. The medicine that was injected may cause elevated blood sugar levels.

Call Your Doctor

Call your doctor if any of these occur:

• Severe pain or headache
• Fever or chills
• Increased arm weakness or numbness
• Problems swallowing
• Redness, swelling, increasing pain, bleeding, or discharge from the injection site

If you have an emergency, call for medical help right away.