Do you sometimes feel a sharp pain or numbness that radiates from your neck to your shoulders and arms? You may be suffering so much from this pain that you can't even do your daily tasks properly. Today, we are going to talk about one treatment for this type of severe neck pain. That is a special steroid injection given to the cervical spine.
Simply put, what is this injection?
This is what we medically call a cervical epidural steroid injection (ESI) . Although the name sounds a bit complicated, what happens is very simple. It involves injecting a medicine (a type of steroid) that reduces swelling and inflammation into the epidural space , which is the space around the spinal cord in your neck.
The main goal of this is to control chronic pain caused by compression or inflammation of the spinal nerve roots in the neck. We call this pain Cervical Radiculopathy . This pain can start in your neck and spread to your shoulder, arm, and sometimes even your fingers.
A little clarification: The word "cervical" here means "neck." Sometimes this word is used in reference to the uterus, which can cause a little confusion. But remember that in this injection, "cervical" refers to the neck.
How does this injection reduce pain?
Think of our spinal cord as a highway that carries information. Messages from the brain travel throughout the body, and information from the body travels to the brain through this spinal cord. This spinal cord is protected by a series of bones (vertebrae) that are stacked on top of each other. There are 7 of these vertebrae in the neck area.
Sometimes, the jelly-like parts between these vertebrae (we call them discs) can bulge out, pressing on the nerves that come out of there. Or, due to changes that happen with age, the nerve pathways can become narrowed and the nerves can swell. That's when that terrible pain comes.
This injection injects a steroid around the inflamed, pinched nerve . This reduces the swelling and inflammation of the nerve. This reduces the pressure on the nerve and reduces the pain. It also gives the nerve time to heal. However, the pain relief it provides is often temporary . Some people may not get any relief at all.
What conditions is this injection used for?
There are several major medical conditions that can cause pinched nerves in the neck. This injection is most often used for such cases. Let's take a look at what they are.
| Condition | Simply put... |
|---|---|
| Cervical Herniated Disk | This is what we call a "slipped disc." The jelly-like material inside the cushion between two vertebrae bulges out, pressing on a nearby nerve. |
| Cervical Degenerative Disk Disease | As we age, the cushion (disc) between the vertebrae wears out. This can also cause the nerves to become inflamed. |
| Cervical Osteoarthritis (Cervical Spondylosis) | Normal aging causes changes in the bones, discs, and joints of the neck. This can narrow the passageways for nerves and cause them to become compressed. |
| Cervical Spinal Stenosis | The space (the passageway for the nerves) inside the cervical spine narrows. This causes the nerves to become compressed and swollen. |
What happens when the injection is given?
This is done in a hospital or clinic by a specially trained doctor. It usually takes about 15-30 minutes. It is very important that you do not move too much during this time.
These are the steps that usually occur:
- First, you will be put on a hospital gown and made to lie on your stomach on a table.
- Next, the doctor thoroughly cleans the area of the neck where the injection will be given to prevent infection.
- Then a small injection (local anesthesia) is given to numb the area. This will make the larger needle less painful. Sometimes you may also be given a sedative to help you relax.
- After numbing, the doctor uses a special X-ray machine called fluoroscopy to guide the needle to the exact location.
- Once the needle is in the correct epidural space, a type of dye called contrast is sometimes injected. This makes the area more visible on the X-ray. (If you are allergic to the dye, skip this step.)
- Finally, the steroid medication is slowly injected into the area.
- After the injection is finished, the area is pressed to stop the bleeding, cleaned, and a plaster is applied.
- Then they'll let you rest for a while to see if there are any side effects. If everything is fine, they'll let you go home.
Does it hurt a lot when you give this?
When you get the numbing medicine, you don't feel much pain. Sometimes you may feel a slight tingling, a burning sensation, or a stinging sensation. This will go away once the injection is over. However, if you experience unbearable pain during or after the injection, you should tell your doctor right away.
What to expect after the injection?
After you go home after the injection, you may feel some pain where the needle was inserted for a few hours. This is normal.
If you are given a numbing medicine, your neck, shoulders, and arms may feel a little heavy or numb. This will go away after a while. The most important thing is that the pain may increase a little for the first two or three days after the injection . Don't worry about it. This is normal. The pain will start to subside within two to seven days. This relief can last from a few days to a few months.
What are the benefits and risks of this?
As with any medical treatment, there are benefits and some risks. It's important to discuss both with your doctor.
| Advantages | Risks & Complications |
|---|---|
| Getting temporary relief from pain. | Low blood pressure, dizziness. |
| Being able to do physiotherapy exercises properly due to less pain. | Severe headache caused by cerebrospinal fluid leak. |
| Being able to do daily tasks easily. | Infection at the injection site (very rare). |
| Perhaps not requiring major treatment such as surgery. | Damage to a blood vessel, resulting in bleeding or clot formation. |
| Nerve damage due to needle puncture (very rare). | |
| Weakening of the bones of the spine due to frequent injections. |
Important: Most of these risks are very rare, especially when performed by a doctor who is well-trained in this area.
When should I see a doctor as soon as possible?
If you experience any of the following symptoms after receiving the injection and going home, call your doctor immediately, or go to the Emergency Department (ETU) of the nearest hospital.
- If you have a severe headache that comes on when you stand up, but subsides when you lie down .
- If you have a fever (this could be a sign of an infection).
- If you experience persistent numbness or weakness in your hands (this could be a sign of nerve damage).
Take-Home Message
- This injection is a treatment for pain that radiates down the arm, caused by nerve compression in the neck.
- This does not provide permanent relief from pain, but temporary relief .
- The main goal is to reduce pain and allow you to properly perform physiotherapy exercises. Strengthening the muscles around your neck can provide long-term relief.
- Although this is generally a safe treatment, there are some minor risks, so be sure to discuss all of these with your doctor before undergoing the treatment.
- Be aware of the dangerous symptoms that may occur after treatment. If any problems arise, seek medical advice immediately.
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