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WHAT IS A CERVICAL EPIDURAL STEROID INJECTION (CESI)?
CESI is the placement of anti-inflammatory medication (similar to cortisone) close to injured discs or nerves in the neck. The steroid is injected to try to stop the release of painful chemicals, to reduce swelling of nerves and thus promote healing. The goal is to reduce pain, numbness and tingling in the neck, arms and hands and possibly avoid surgery. It may also relieve headache symptoms.
These steroids are designed to be effective for one to two weeks. The steroid may provide benefit for a longer period of time. The injection may be repeated after two weeks. The steroid may be injected along with a local anesthetic, providing immediate temporary pain relief. The pain may return after several hours. Pain relief due to the steroid may begin in 24 to 48 hours. Not everyone will benefit from the steroid. Sometimes the pain can get worse
WHAT IS THE EPIDURAL SPACE?
The brain, spinal cord and the nerves that emerge from the spinal cord are surrounded by spinal fluid. The epidural space surrounds the spinal fluid, spinal cord and nerves. It contains nerves, fat and blood vessels.
HOW IS IT DONE?
There are different approaches to the CESI:
| One is between the cervical vertebrae bones, in a relative midline approach. (Translaminar or interlaminar epidural steroid injection) This approach is designed to spread steroid over a large area. This may more desirable if there are several damaged discs or if symptoms are on both sides. A small volume of local anesthesia and steroid place at the base of the neck often will spread to the upper neck epidural space. |
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| Another is from the side at the openings through which the nerves pass on their way to the arms and hands. (Select nerve block / Transforaminal Epidural Steroid Injection). This is more often used for placement of the steroid around specific nerves, and also if you have had previous neck surgery. |
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The best approach is determined by factors such as history of previous surgeries, referring doctor’s request, symptoms, and the MRI studies. Fluoroscopy (moving x-ray) is used with each procedure to help insure both accuracy and safety.
TIME?
The CESI is usually done in less than 30 minutes. Light sedation helps to make the patient comfortable during this procedure.
RISKS
There are side effects and potential risks associated with this procedure.
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