Epidural Steroid Injection, Cervical Spine

KEY FACTS

Terminology

• Percutaneous injection of glucocorticoid into cervical epidural space

  • Interlaminar: Approach epidural space between lamina

  • Transforaminal: Approach epidural space via neural foramen

Preprocedure

• Indication

  • Cervical pain &/or cervical radiculopathy

• Coagulopathy

• Preprocedure imaging

  • Assess adequate epidural space to accommodate needle placement/injection

Procedure

• Loss of resistance/free injection of saline reveals tip in epidural space (or intrathecal)

  • Inject contrast to verify needle tip placement

Post Procedure

• Expectation

  • Improvement in, or eradication of, pain at level of injection

  • Steroid may take 48-72 hours to reach maximum therapeutic effect

Outcomes

• Most feared complications

  • Direct spinal cord injury or intraspinal hematoma

  • Intrathecal injection of anesthetic/respiratory paralysis

TERMINOLOGY