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.
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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.
Potential problems are rare. But, all procedures have some risk. Your doctor will review potential problems, like: Increase in painBleeding or fluid leakage in spinal canalInfectionSpinal headachesNerve damageAllergic reaction to the medicine used (eg, hives, light-headedness, low blood pressure, wheezing)
may increase your risk of complications.
Your doctor may not want to do this injection if you have: Not tried other conservative treatmentHad success with conservative treatmentAllergies to the local anesthetic, x-ray contrast, or medicines being usedLocal skin infection
An infection (eg,
Bleeding disorder or take blood-thinning medicinePain that is due to infection or malignancy
high blood pressure
congestive heart failure
Talk to your doctor about these risks before the 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,
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 warfarinAnti-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.
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.
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.
The nurse will place a small bandage over the injection site. You may be able to go home after being observed by the nurses.
The injection only takes a few minutes. The entire procedure may be 30-60 minutes.
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.
Your doctor will assess your level of pain relief.
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 if any of these occur: Severe pain or headacheFever or chillsIncreased arm weakness or numbnessProblems swallowingRedness, swelling, increasing pain, bleeding, or discharge from the injection site
If you have an emergency, call for medical help right away.
Cervical epidural. University of Wisconsin School of Medicine and Public Health: Radiology Department website. Available at:
Accessed March 19, 2012.
Cervical epidural steroid injection. University of California San Diego website. Available at:
http://health.ucsd.edu/specialties/cppm/injections/Pages/cervical-epidural-steroid-injection.aspx. Accessed March 18, 2012.
Cervical radiculopathy: non-operative treatments and cervical epidural steroid injection. Hospital for Special Surgery website. Available at:
http://www.hss.edu/conditions_cervical-radiculopathy-nonoperative-treatments-epidural.asp. Accessed March 18, 2012.
Epidermal injections. American College of Radiology website. Available at:
http://www.radiologyinfo.org/en/info.cfm?pg=epidural. Accessed March 18, 2012.
Spinal injections. Rehabilitation Institute of Chicago Spine and Sports Rehabilitation Center website. Available at:
http://www.ric.org/conditions/sportsmed/SpinalInjections.aspx. Accessed March 19, 2012
Last reviewed June 2013 by Teresa Briedwell, DPT, OCS
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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