Cervical Epidural Injection

Excerpt

Many individuals with cervical radiculopathy may experience symptom relief through cervical epidural injections, particularly when conservative treatments—such as rest, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and cervical collars—fail to provide adequate relief after 6 to 8 weeks. These injections are typically reserved for patients whose symptoms persist despite non-invasive therapies, provided there is no evidence of progressive neurological decline. Cervical radiculopathy affects approximately 107 per 100,000 men and 63 per 100,000 women annually, with peak incidence between ages 40 and 60.

While most cases resolve without invasive intervention, epidural injections can offer substantial relief in refractory cases, with about 50% of patients achieving a 50% reduction in pain lasting 3 months. A standard treatment plan includes an initial injection followed by 1 or 2 additional injections spaced 2 to 4 weeks apart. Common causes of radiculopathy include degenerative disc disease, spondylolisthesis, and cervical spinal stenosis, with nerve root compression being the most frequent source. The transforaminal approach offers more precise targeting but carries higher risks, including infection, spinal headaches, nerve injury, and, rarely, paralysis or death. In select cases, catheter-based techniques—utilizing a 20-gauge catheter advanced through a loss-of-resistance syringe—may provide access to higher cervical levels, particularly at the cervicothoracic junction.