Cervical epidural steroid injection with intrinsic spinal cord damage

Evidence from multiple observational studies suggests that transforaminal or interlaminar CESI’s can provide significant relief lasting 6 months or longer for anywhere from 40-60% of patients (Robinson & Kothari, 2012).  In one clinical trial, 72% of patients with neck pain and cervical radiculopathy experienced immediate pain relief following CESI of an intra-laminar approach (Kwon, et al., 2007). Studies have concluded that CESI’s are a safe and effective modality for the treatment of patients experiencing chronic neck pain and associated radiculopathy, however pain relief may vary from person to person, however, as relief lasts longer for some patients than it does for others.  In many cases, studies have found pain relief from CESI to be significant enough to prevent patients from needing to consider surgical interventions for chronic pain (Abdi & al., 2007).

This is a rare complication that may occur if a small hole is made in the fibrous sac and does not close up after the needle puncture. These small holes are only made in less than 1% of epidural injections and usually heal on their own. The spinal fluid inside can leak out, and when severe, the brain loses the cushioning effect of the fluid, which causes a severe headache when you sit or stand. These types of headaches occur typically about 2-3 days after the procedure and are positional - they come on when you sit or stand and go away when you lie down. If you do develop a spinal headache, it is OK to treat yourself. As long as you do not feel ill and have no fever and the headache goes away when you lay down, you may treat yourself with 24 hours of bed rest with bathroom privileges while drinking plenty of fluids. This almost always works. If it does not, contact the radiologist who performed the procedure or your referring physician. A procedure (called an epidural blood patch) can be performed in the hospital that has a very high success rate in treating spinal headaches.  

Epidural injections can be performed from several different approaches; these include a caudal, interlaminar, or transforaminal approach. The approach your provider chooses is based on each individual patient’s clinical presentation, the personal preference and experience of the provider performing the injection, the desired outcome, and most importantly, the risks versus benefits of performing one type of epidural over another. Clinically, the purpose of all epidural injections is to place a mixture of steroid and local anesthetic at the source of the problem to decrease inflammation causing pain, and to promote healing and clinical improvement. The epidural steroid injection involves placing steroid medication in the inflamed area and significantly reduces nerve irritation thus improving pain. This treatment option has the potential to completely resolve pain and ultimately may prevent operative treatment.

Cervical epidural steroid injection with intrinsic spinal cord damage

cervical epidural steroid injection with intrinsic spinal cord damage

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