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What Is Cervical Epidural Steroid Injection
A cervical epidural steroid injection is a minimally invasive procedure in which a mixture of long-acting corticosteroid (to reduce inflammation) and local anesthetic (for immediate pain relief) is injected into the epidural space around the spinal cord in your neck (cervical spine). The goal is to decrease nerve inflammation and provide pain relief for conditions such as herniated discs, spinal stenosis, or radiculopathy (“pinched nerve”).
What conditions can be treated with a cervical epidural steroid injection?
Common conditions include:
- Cervical radiculopathy (arm pain, numbness, or weakness from a pinched nerve)
- Herniated or bulging cervical disc
- Cervical spinal stenosis
- Degenerative disc disease
- Post-herpetic neuralgia (shingles pain) in the neck/shoulder area
- Chronic neck pain with radiating symptoms that has not responded to conservative treatment
What conditions can be treated with a cervical epidural steroid injection?
Common conditions include:
- Cervical radiculopathy (arm pain, numbness, or weakness from a pinched nerve)
- Herniated or bulging cervical disc
- Cervical spinal stenosis
- Degenerative disc disease
- Post-herpetic neuralgia (shingles pain) in the neck/shoulder area
- Chronic neck pain with radiating symptoms that has not responded to conservative treatment
How long does the pain relief last?
- Immediate relief from the local anesthetic usually lasts a few hours.
- The corticosteroid typically begins working in 1–7 days and can provide relief lasting from several weeks to several months (most patients average 1–3 months).
- Some patients experience long-term or permanent relief after 1–3 injections.
How are the Procedures done?
- Performed in an outpatient setting (usually 10–20 minutes)
- You lie face down on an X-ray table
- The skin is cleaned and numbed with local anesthetic
- Using live X-ray (fluoroscopy) guidance, the physician inserts a thin needle into the epidural space
- Contrast dye is injected to confirm correct placement
- Steroid + anesthetic mixture is injected
- A small bandage is applied afterward
Is the procedure painful?
Most patients feel pressure or a brief burning sensation when the needle is placed, but the area is numbed first. Many describe it as less painful than a cortisone shot in the shoulder or knee.
Do I need a driver?
Yes. Sedation is commonly used, and if used an adult is required to take you home. Also with sedation you are to fast for 8 hours prior to the appointment.
How long is the recovery time?
You rest for 10–30 minutes after the procedure. Most people resume normal activities the next day, but we recommend avoiding strenuous activity for 24–48 hours.
What should i expect after the injection?
- Mild soreness at the injection site for 1–2 days (ice and over-the-counter pain medication usually help)
- Temporary numbness or weakness in the arms (usually resolves within hours)
- Possible flushing, slight weight gain, or mood changes from the steroid (usually mild and temporary)
- Gradual improvement in your usual neck/arm pain over the next 1–7 days
How many injections can I have?
Most guidelines recommend no more than 3–4 injections in a 12-month period to minimize steroid side effects.
What are the risks and side effects?
Common (usually temporary):
- Temporary pain at injection site
- Headache (1–2%)
- Flushing, sweating, or warmth
- Temporary numbness or weakness in legs
- Sleeplessness or anxiety for 1–2 days
- Slight increase in blood sugar (important for diabetics)
Rare but serious (<1%):
- Infection
- Bleeding
- Nerve injury
- Dural puncture (spinal headache)
- Allergic reaction to medication
- Very rare: paralysis or death
Are there any contraindications?
Yes. The procedure is typically not performed if you have:
- Active infection or fever
- Bleeding disorder or taking blood thinners (some can be held)
- Uncontrolled diabetes or congestive heart failure
- Allergy to contrast dye or local anesthetics
- Pregnancy
How should i prepare for the procedure?
- Stop blood thinners (aspirin, Plavix, Coumadin, Eliquis, etc.) only if cleared by your prescribing doctor.
- Inform us if you have diabetes (we may adjust insulin/medications).
- Do not eat or drink for 4–6 hours before if sedation is planned.
- Bring a driver.
Is there anything I should avoid after the injection?
- No soaking in a tub, pool, or hot tub for 48 hours.
- Avoid strenuous activity or heavy lifting for 24–48 hours.
- You may resume normal activities the next day if feeling well.
