A herniated disc may cause pain that goes from the neck down the arm to the hand and fingers. If this herniation is large and associated with arm or hand weakness then surgery may be indicated. However, for pain relief, your doctor may recommend epidural steroid injections.  The epidural injection delivers an anti-inflammatory steroid into the epidural space to reduce the inflammation around the nerve roots to decrease the pain.  Note: If you are having difficulty controlling your bowel movements or bladder function you should seek emergency treatment immediately.

Needle position in the transforaminal epidural injection in spine model.

There are 2 basic methods of performing cervical epidural steroid injections under fluoroscopy, an x-ray like process that helps the doctor guide the needle.

• Transforaminal: This technique enters the epidural area from the side where the nerves come out. The transforaminal approach allows more targeted placement of the medications.  Contrast dye is used to verify that the needle is in the correct position.  
• Interlaminar: This is performed for relief of pain going from the neck to the shoulder, arm or hand and may be done from the back of the neck or the side of the neck.  A combination of numbing medicine and anti-inflammatory steroid medication is injected into the epidural space to decrease the inflammation around the nerve root to the arm and hand that is causing pain.        

What to Expect:
You will be given an intravenous catheter (IV) and taken to the procedure room. Monitors will be placed on you to track vital signs.                    

The cervical epidural injection may be performed with you lying face down or on your back on the operating room table. Your neck and possibly your upper back will be cleaned off with a sterile solution and a sterile drape placed to keep the area clean. You should not reach into the area that has been cleaned or you risk infection. Using x-ray (fluoroscopy) as guidance, a needle is placed at the level of the foramen in the neck (transforaminal) or between the bones of the neck (translaminar). Dye is injected to help determine whether or not the needle is in the right position and numbing and anti-inflammatory steroid medications are then injected into the epidural space.

It is very important during any cervical spinal injection procedure to let your physician know immediately if you feel a sudden pain or throbbing sensation going down your arm to your hand or shoulder.

Following the Procedure:
Sometimes the steroid is irritating and causes some temporary neck soreness.

Following the procedure, you will be asked to complete a PAIN DIARY to develop a record of your pain that provides information our doctors can use.