If you've been suffering with neck or upper back pain, your doctor might recommend a cervical epidural steroid injection. During this procedure, a needle is used to inject a steroid solution around the upper part of the spinal cord. It can be extremely effective. Most side effects are minor and cervical epidurals are generally safe. However, as with any medical procedure, there is the potential for side effects, allergic reactions and, rarely, even death.
Pain at the Injection Site
Bleeding or bruising at the injection site are the most common symptoms, usually occurring fairly soon after the procedure. These symptoms are generally not serious and resolve on their own. An increase in the original back or neck pain, or new pain in an arm or leg, can also occur in the days after injection. These symptoms are also usually temporary and short-lived. Reactions to the steroid-anesthetic mixture itself have also been reported, including an increase in blood sugar in diabetics.
During a cervical epidural injection, the injected steroid solution is intended to bathe the outside of the spinal cord. However, because the outer membrane of the spinal cord is less than 1 mm thick, it can be inadvertently punctured by the needle. The puncture can lead to leakage of some of the fluid that surrounds the spinal cord. Changes in the fluid pressure can cause headaches, which may last only a short time or persist, and which are often worse when standing. Headaches may also occur when there has been no puncture or leakage of fluid. The author of a study published in the March 2009 edition of "Current Reviews in Musculoskeletal Medicine" found that headaches occurred in 4.6 percent of patients undergoing a cervical epidural.
When a procedure involves a needle, there is always the risk of infection. A recent study in the March 2012 issue of "Pain Physician" found an infection rate of 0 among the cases included for study. Although the risk is low, it is always there. Inflammation of the membranes surrounding the spinal cord and brain, or meningitis, is one potentially life-threatening consequence of infection. Another is a collection of pus, or abscess, that can put pressure on the spinal cord as it expands in an enclosed space. Infections of the neck vertebrae and discs can also occur. Seek emergency medical care for fever, new weakness or mental status changes like altered awareness or responsiveness within the first few days after a cervical epidural
Rare but Serious Complications
Rare but serious complications include temporary blindness and paralysis, which is often transient but can be permanent. Cardiac arrest has also been reported immediately after a cervical epidural injection, possibly due to an air bubble blocking a critical nerve and severely decreasing the heart rate. Any chest pain, lightheadedness, abnormal heart rhythms, changes in your vision or new numbness or weakness in your arms or legs should be immediately reported to your doctor.
Warnings and Precautions
If you develop symptoms of any of the serious side effects of a cervical epidural injection, call your doctor immediately. Seek emergency medical care if you experience changes in your thinking, fever, worsening neck pain, new numbness or weakness, or chest pain.
Is This an Emergency?
- Pain Physician: A Prospective Evaluation of Complications of 10,000 Fluoroscopically Directed Epidural Injections
- Epiduroscopy: Spinal Endoscopy; Gunter Schutze
- Current Reviews in Musculoskeletal Medicine: Cervical Epidural Steroid Injections in the Management of Cervical Radiculitis: Interlaminar Versus Transforaminal. A Review
- Surgical Neurology International: The Risks of Epidural and Transforaminal Steroid Injections in the Spine: Commentary and a Comprehensive Review of the Literature
- Pain Physician: Cardiopulmonary Arrest Following Cervical Epidural Injection