Cervical Epidural Steroid Injection

Cervical epidural steroid injection or cervical epidural is performed for chronic pain in neck as well as upper extremities. Chronic pain also is called as radiculopathy. Radiculopathy pain may be associated with tingling, numbness as well as weakness in the upper extremities. One of the treatment for radiculopathy pain is cervical epidural injection.

Procedure is performed in the operating room under aseptic surrounding. Patient is brought in the surgical room and asked to lie down in prone position. Procedure is performed either with or without sedation. The skin over the neck from level C2-T1 is spread with antiseptic solution as suggested by the joint commission and surgical center. Following the skin prep, the skin is covered with sterile drip and local anesthesia is used to anesthetize the skin as well as subcutaneous tissue. The skin is anesthetized with 23 guage smaller thin needle, local anesthesia used is 1% Lidocaine, and amount injected is between 1 to 3 cc.

Following local anesthesia, the cervical vertebrae is identified by using x-ray. X-ray is used both in anterior posterior view and lateral view to identify the space of the epidural where the medication will be injected. Most often C5-C6, C6-C7, and C7-T1 space is selected for epidural steroid injection. After local anesthesia, the epidural needle under the guidance of the x-ray is inserted into the epidural space. After the needle is inserted into the epidural space, dye is injected. After satisfactory spread of the dye in cephalic and caudal directions as well as lateral direction, medication are injected in to the epidural space. Medication injected is corticosteroid such as Depo-Medrol or Kenalog. The amount injected is between 40 to 80 mg. In some center solid cortex as the corticosteroid also is injected. The corticosteroid may be mixed with normal saline for dilution. Local anesthesia is rarely injected into the cervical steroid space because there may be few rare cases where the needle may be in the subdural space and local anesthesia may cause total spinal block. After the injection, patient is observed in the recording room before discharge and patient is observed for the pain control.