Cervical Epidural Injection

What is a Cervical Epidural Injection?

A cervical epidural is an injection of a steroid mixture into the spine in the lower part of the neck. The epidural space lies inside the bony spine. The spinal cord and spinal nerves are contained inside a fluid filled sac surrounded by a thin skin which is called the dural membrane. An epidural injection aims to spread the injected drug just outside this covering.

Why is it done?

Epidural steroids are given to relieve pain arising as a result of irritation of the nerves in the upper spine and neck, and can relieve nerve pain affecting your arms. The pain reduction however may not be permanent and the duration of pain reduction may vary. However, epidural injection may not relieve the neck pain.

How does it work?

The injectate we use is a mixture of a local anaesthetic and steroid. Local anaesthetics numb the nerves, giving short-term, and sometime longer term, pain reduction. The steroids have a long-term effect by reducing swelling (inflammation) and irritation around the nerves. The steroids are not licensed for this use, but they are commonly used and we have no reason to doubt that this is a safe use of these medicines (unlicensed medications are commonly used if there are no licensed medications available to treat a particular problem).

Before the injection?

If you are taking Warfarin/Clopidogrel/ Apixaban (or any other blood thinning medicine) then you will probably need to stop this for a short time before the injection. The potential risks of stopping these medicines will be discussed in the clinic before the injection, and your pain doctor will give you specific instructions. 

If you take diabetic medication, then management of your diabetes around the procedure will be discussed with you in the clinic.

How is it done?

An epidural injection is performed as a day case procedure. The risks and benefits will be discussed with you in the outpatients department and a consent form completed. You will be admitted to the day ward and seen by one of the pain doctors who will ask you if you have any further questions about the procedure. Shortly before the procedure you will need to change into a hospital gown.

For this injection you will lie on your tummy on an operating table, on a special mattress with a special ring shaped pillow, and the doctor may have do some adjustments to how your shoulders and arms are positioned while doing X rays. You will have a plastic cannula (needle) placed in the back of your hand. We will monitor your breathing and circulation. You will remain awake for this procedure so that the doctor can maintain constant communication with you. Your neck and upper back will be cleaned with a cold antiseptic solution. This injection is performed at the lower end of the neck using X-rays to ensure that the needle is in the right position. Local anaesthetic is first injected into skin to numb the area. X-ray dye is used to check that the spread of the injection is satisfactory, this may require the doctor to take a number of X rays and it is advisable that you keep still at this time. There may be some discomfort in the back of the neck, and a sensation of warmth in the arms, during the injection.

Occasionally the injection cannot be done because the anatomy in this area can vary or be too complex to proceed safely. Alternative treatments may have to be discussed at a later date.

After the injection?

After the procedure a small dressing will be applied at the site of injection, which can be removed after a few hours. We suggest that you do not drive, operate machinery or drink alcohol for 24 hours following this procedure.

What are the side effects?

1. The injection may fail to help you, or the benefit may be very short lived
2. The injection may make your normal pain worse for a few days.
3. The steroid may affect menstrual periods in ladies for one to two cycles.
4. The steroid may also cause fluid retention for a few days.
5. The injection may cause pain at the site of injection for one or two days.
6. Some patients experience headache following an epidural (very rare). Usually it improves with rest and pain killers such as Paracetamol. If it does not settle then please contact your GP and the Walton Centre.
7. Infection is a possible risk but is extremely rare.
8. You may feel facial flushing for two to three days after an epidural injection.
9. There is a small chance that the injection will make the pain permanently worse, or may fail to help you at all.
10. Risk of blindness has also been reported but extremely rare
11. Other very rare risks include nerve damage and paralysis
12. There is a small risk of ‘vasovagal’ (temporary fainting episode) during the procedure but this can be managed by the pain doctor.

Who do I contact if I have any problems after the procedure?

Your first point of contact will be your own GP, or the out of hours GP.

You can also contact the Walton Centre Pain Clinic during normal working hours, on 0151-55-63390, and ask to speak to the secretary of the doctor who did the procedure.

If you require any additional information or you have any further questions, then please discuss this with your consultant prior to starting the treatment.