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Improving Results of Cervical Epidural Injections

When conservative care (meaning nonsurgical treatment) doesn't help with cervical radicular syndromes, epidural injections may be the next step. Neck and arm pain, numbness, tingling, and weakness that persist for weeks or months may lead to the decision to try an injection.

The injection is called an interlaminar cervical epidural steroid injection (ICESI). A steroid and numbing solution is injected into the epidural space. The epidural space is between the dura (protective lining inside the vertebra) and the inside of the spinal canal.

An interlaminar injection is done by placing the needle directly in from the back of the spine. The tip of the needle goes between the laminae of two adjacent vertebra. The laminae is the part of the vertebra that forms the bony ring around the epidural space and the spinal cord.

ICESI is a safe treatment but complications are reported. In this review article, the minor and major problems that can occur with ICESI are discussed.

Minor complications occur within the first 24 hours. They can be treated easily and often go away on their own. Neck pain, headache, dizziness, and facial flushing are the most common effects. Nausea, vomiting, and fever may occur. Some patients report arm weakness, insomnia, and tenderness at the injection site.

Major complications are rare but can include a hematoma (pocket of blood), infection, and nerve root injury. Puncture of the dura is a complication that leads to another problem: severe headache. More serious problems such as permanent spinal cord injury and/or death can also occur.

The authors suggest that knowing what potential complications can occur should help the injectionist to avoid these problems. Some specific measures to prevent complications are also provided.

For example, patient movement must be kept to a minimum. The site of injection should be chosen carefully based on MRI results. Injections are best done at two sites: C7-T1 and C6-C7.

When problems do occur, quick identification and treatment gives the best results. More studies are needed to standardize injection techniques. This may help prevent or reduce both minor and major complications of ICESI.

References: Arjang Abbasi, DO, et al. Complications of Interlaminar Cervical Epidural Steroid Injections. A Review of the Literature. In Spine. September 1, 2007. Vol. 32. No. 19. Pp. 2144-2151.

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