Cervical Epidurals

Epidural steroid injections to the cervical spine are common ways to intervene in cervical pain when non-injectable ways have failed. It involves using long acting steroid in suspension and injecting it into the epidural space. Medical evidence has shown that this technique is efficacious when it comes to pain control. It has a high safety margin so that it is recommended for use in many cervical pain situations. The only procedure with somewhat less safety and efficacy is the cervical epidural injection using a transforaminal approach. The procedure is done with the use of local anesthetics along with the steroid preparation. Of all cervical pain procedures, the cervical epidural procedure is the most common.

One research study looked at the use of cervical injection into the epidural space and found that there was no difference between straight steroid injection and the use of steroids and bupivacaine, used in local anesthesia.

Cervical epidural injections do have a minimal potential of having severe and devastating injections, however in one study, out of a total of 5,968 patients who had cervical epidurals, there were only 23 minor complications in the transforaminal group. There were five minor complications in regular cervical epidurals but no serious complications were had in either group.

One researcher (Botwin, et al) reviewed 157 patient charts that had a total of 345 interlaminar epidural steroid injections. There was a 16.8 percent rate of complications, none of them severe. The main side effects were increased neck pain, headaches that resolved within a day, facial flushing, vasovagal reactions, fever and dural puncture rather than an epidural puncture. All side effects were transitory and similar to those seen in lumbar epidural injections.

A few patients had serious complications, including vertebrobasilar brain infarcts, and cervical spinal cord infarct or both. All were considered serious complications. Some deaths are reported. The degree of infarct determined the rate of death. Bilateral lesions were considered the worst. Three deaths were reported as a result of a high cervical epidural. Two patients suffered from seizures. One patient died from brain herniation. TIAs were noted and a case of blindness happened due to air embolism. Most of the severe cases occurred using the transforaminal approach.

Because the transforaminal approach is the most dangerous, many doctors defer to the interlaminar approach in doing the cervical epidurals.