The ‘epidural’ refers to a space around the spine through which nerve roots leave the spinal cord. Before nerves can travel from the spine into the arms, chest, and legs, they travel through the epidural space, and exit through small nerve holes. The cervical (neck and upper spine) epidural space is a portion of the spine in the neck where inflamed nerves can be located. It is a common source of a variety of painful conditions in the neck, including chronic pain.
Epidural Steroid Injections
A cervical epidural steroid injection (often shortened to ‘epidural procedure’ or just ‘epidural’) is a treatment in which a mixture of local anaesthetic (bupivicaine) and anti-inflammatory steroid (depo-medrone) is administered into the epidural space. The aim is to reduce inflammation and provide pain relief in the affected area of the spine.
The patient is asked to lie on their stomach and a local anaesthetic is used to numb a small area of skin on the back. The tip of a fine needle is carefully placed in the epidural space, which administers the solution of local anaesthetic and anti-inflammatory steroid.
Sedation may be used if patients are nervous, but the procedure is extremely tolerable and it’s usually unnecessary. The epidural takes around 15-20 minutes and is done as a day-case, with no overnight stay required.
There may be some local discomfort from the administration of local anaesthetic and there is sometimes a small bruise at the site of the procedure. Occasionally patients get temporary numbness in the legs due to the local anaesthetic, which wears off after a few hours. Infection is a possibility but rare as full sterile precautions are taken.
The steroid takes 4-10 days to reach its maximal anti-inflammatory and pain relief potential. With an effective epidural, a patient can receive several months of pain relief. This pain-free window is the ideal time to rehabilitate the back in conjunction with physiotherapy. Rehabilitation is based on exercises and movements designed to help build a strong, healthy and pain-free back.
Epidurals can be very successful in many patients at producing pain relief. For those who get the benefits of pain relief, sometimes only one block is required. For others, the relief lasts several months. Often these patients will have the procedure performed 3-4 times per year to maintain their pain-free window. In other patients the technique may not be successful and other methods can be explored, such as facet joint injections or facet joint radiofrequency.