What is a cervical epidural?
Epidural injections into the upper spine, are used to treat a number of different painful conditions. The condition most often treated is cervical disc prolapse causing brachalgia (referred arm pain). This is a condition similar to sciatica, which affects the leg. Sciatica is caused when problems in the spine cause pain to radiate down the leg. Similarly, with brachalgia, problems in the neck can cause pain to radiate down the arm.
The injection is usually given intothe back of your neck. The needle is inserted between the vertebrae (neck bones), into an area known as the epidural space. This is a space that surrounds the spinal cord and contains nerves that carry painful sensations . The injection is just outside the covering of the spinal cord, which is called the dura; hence the name epi-dural.
What is the epidural space?
The membrane that covers the spine and nerve roots in the neck is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the neck, shoulder and arms. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract with the bony structure of the spine in some way.
An epidural injection is good at targeting the area of inflammation The injection bathes the nerves and intervertebral discs in local anaesthetic and steroid solution. Only a small amount of corticosteroid is needed and it will not cause any of the side effects sometimes associated with taking other forms of steroid. The injection relieves pain and inflammation. Arm pain, caused by inflamed nerves in the spine, can be treated in this way. Bathing inflamed discs in this way may also reduce some neck pain.
The aim of the procedure is to reduce the inflammation of the intervertebral disc. This will relieve your arm pain and some of your neck pain. An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the neck, shoulders and arms. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.
Your pain should be reduced and you should be able to move around more easily. You can then exercise to prevent the problem happening again. If successful, this treatment can avoid the need for surgery.
By the time you consider a cervical epidural you should have already tried other more simple treatments. These include rest, painkilling and anti-inflammatory tablets, and physiotherapy with exercise.
You may also have tried a transcutaneous electrical nerve stimulation (TENS) machine for your pain. This works by sending soothing pulses across the surface of the skin and along the nerve fibres. These pulses prevent pain signals from reaching the brain. They also stimulate your body to produce higher levels of its own natural painkillers, called endorphins.
What if you do nothing?
If you do nothing there are several things that may happen:
With time and rest the inflammation and pain may settle on its own
The pain and difficulty in moving around may stay the same
The pain may increase
The disc may become more damaged and may injure the nerves that control movement. You may then develop weakness and difficulty in moving your arms. Some of this may be permanent
In severe cases you may also lose control of your legs, and even your bladder and bowels, as the nerves that control these are damaged.
Who should have it done?
The following groups of patients should have the procedure done:
Patients with arm pain caused by inflamed intervertebral discs
Patients with neck pain that has not settled by other means
What happens during the procedure?
An IV is started so that relaxation medication can be given. The patient is placed sitting in a chair and positioned in such a way that the physician can best visualize the neck using x-ray guidance. The skin on the back of the neck is scrubbed using 2 types of sterile scrub (soap). Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a small needle, using x-ray guidance into epidural space. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the epidural space. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.