Healthcare providers use cervical epidural steroid injections (ESIs) as a temporary pain relief option for certain causes of chronic neck pain. They inject an anti-inflammatory medication into the epidural space around your spinal nerves. About 40% to 84% of people who receive cervical ESIs experience temporary pain relief.
A cervical epidural steroid injection (cervical ESI) is an injection of anti-inflammatory medicine — a steroid or corticosteroid — into the epidural space around the spinal nerves in your neck.
The main goal of cervical epidural steroid injections is to help manage chronic pain caused by irritation and inflammation of the spinal nerve roots in your neck (the cervical region of your spine) due to certain conditions or injuries. This type of chronic pain is called cervical radiculopathy, which can radiate down from your neck to your shoulders, arms and/or hands.
“Cervical” comes from the Latin word “cervix,” which means “neck.” In the case of cervical ESIs, the injection is in your neck, not your cervix. The cervix, the narrow passage forming the lower end of the uterus, is called so because it’s a neck-like passage.
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Healthcare providers use cervical epidural steroid injections (cervical ESIs) for chronic pain management. Your provider injects a steroid or corticosteroid medication into the epidural space around the spinal cord in your neck.
The neck region of your spine is called the cervical spine. This region is made up of seven vertebrae. Your vertebrae are the 33 individual, interlocking bones that form your spinal column, which runs from the base of your skull to your tailbone. These bones help protect your spinal cord from injury. Between the vertebral bones are disks that provide cushioning for your vertebrae and flexibility for you.
The seven vertebrae in your cervical spine are named C1 through C7 from top to bottom. The cervical vertebrae have several important roles, including:
Your spinal cord is a very important bundle of nerves that runs from your brain to your lower back. Your spinal cord acts like a highway that connects the nerves located all over your body to your brain so that your brain can send signals and communicate with the rest of your body.
Sometimes, nerve roots that are attached to the cervical region (neck region) of your spinal cord can become pinched or inflamed. This can happen, for example, if you have a herniated disk. The inflamed nerves can cause pain, and the pain may radiate down your shoulder and/or arm.
During a cervical epidural steroid injection procedure, your provider injects a steroid into the epidural space around your spinal cord. The epidural space surrounds your spinal cord like a sleeve and contains the following tissues:
The steroid coats the irritated nerve(s) that are causing your pain and works to reduce swelling and pressure on the nerves. The steroid allows the nerve(s) time to heal.
Cervical epidural steroid injections most often lead to temporary pain relief, but some people do not experience pain relief from the injection.
Healthcare providers use cervical epidural steroid injections to manage a type of chronic pain known as cervical radiculopathy, which is caused by spinal nerve root inflammation and irritation in your neck. Cervical radiculopathy can cause the following symptoms, which can radiate down from your neck to your shoulder, arms and/or hands:
Many conditions can irritate your spinal nerve roots in your neck and cause cervical radiculopathy, including:
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Cervical epidural steroid injections are a common form of therapy for certain causes of chronic neck pain. Cervical radiculopathy affects approximately 1 in 1000 adults per year, and neck pain is the fourth leading cause of disability in the United States. Over the past decade, the rate of cervical ESIs has doubled among people who have Medicare (the federal health insurance for people who are 65 years or older) in the United States.
Cervical epidural steroid injections are very technique-sensitive, so healthcare providers performing the injection must have significant specialized training. Healthcare providers who may perform cervical ESIs include:
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Before your cervical ESI, it’s important to tell your healthcare provider if you are pregnant or might be pregnant due to the possible use of fluoroscopy imaging (a type of X-ray imaging) during the procedure. You also need to tell your provider which medications you are taking, including herbs, supplements and other non-prescription drugs.
Your healthcare provider will give you specific instructions about what you need to do to prepare for your ESI injection. Be sure to follow their instructions. Your provider may:
Questions that may be helpful to ask your healthcare provider before you get a cervical epidural steroid injection include:
You will likely have your epidural steroid injection in a hospital or an outpatient clinic. In most cases, a cervical ESI takes 15 to 30 minutes. It’s important to be very still during this procedure.
The two most common approaches to cervical epidural steroid injections are transforaminal (TFESI) and interlaminar (IESI). These two methods describe the path your healthcare provider uses to get to the epidural space around your spinal cord.
For an interlaminar ESI, the path of the needle is in between two laminae in your spine to get to the epidural space. A lamina is the flat plate of bone that’s part of each vertebra in your spine. The laminae in your spine form the outer wall of the spinal canal and protect your spinal cord.
For a transforaminal ESI, the path of the needle is through the foramina, which are openings through which nerve roots exit your spine.
The general steps of a cervical epidural steroid injection procedure include:
You’ll likely experience a minor pinch when your provider injects the local anesthetic to numb the area before your cervical epidural steroid injection.
You may not feel anything during your cervical ESI injection, or you may feel the following:
If you have any discomfort during the injection, it usually disappears once the injection is finished. If you feel intense, sharp pain during or after your ESI injection, tell your provider immediately.
After your injection, you may feel some discomfort where your healthcare provider inserted the needle. This is normal and should only last a few hours.
If your cervical ESI procedure involved a local anesthetic, your neck, shoulder, arm and/or hand may feel heavy or numb after your ESI. This is normal and shouldn’t last very long.
Your provider may tell you to take it easy and minimize your activity level for the rest of the day.
Your pain may become worse for two to three days after your cervical ESI before it begins to improve. Epidural steroid injections start working within two to seven days, and the pain relief can last several days to a few months or longer.
The advantages of cervical epidural steroid injections include:
Cervical epidural steroid injections are usually safe, but there are risks of certain side effects and complications. Although rare, risks and complications that apply to all types of ESI injections include:
While it’s very rare, receiving a cervical epidural steroid injection can lead to some long-term complications, including:
Approximately 40% to 84% of people who receive a cervical epidural steroid injection experience at least partial pain relief. However, some people do not experience any pain relief.
The goal of a cervical epidural steroid injection is typically to provide adequate short-term pain relief so that you can begin or continue physical therapy or to try to avoid more intensive pain relief procedures. Physical therapy may help promote long-term pain relief by strengthening the muscles that support your spine.
If a cervical ESI works for you and results in pain relief, your healthcare provider may recommend another injection later on. However, most providers limit people to two to three cervical ESIs per year.
In many cases, cervical epidural steroid injections provide effective short-term pain relief. Your pain relief may last for several days to months or longer. One study revealed that people who had cervical interlaminar ESIs had pain relief for 12 to 24 months. Cervical ESIs very rarely lead to permanent pain relief.
Unfortunately, some people don’t experience any pain relief from cervical ESIs.
If you experience any of the following symptoms after you’ve returned home from your cervical ESI injection, be sure to contact your healthcare provider or go to the nearest hospital as soon as possible:
A note from Cleveland Clinic
When performed by a skilled healthcare provider, cervical epidural steroid injections are an often effective and generally safe therapy option for chronic neck pain caused by certain conditions. It’s important to remember that a cervical ESI will most likely not cure your neck pain. Rather, it will provide temporary pain relief so that you can return to your normal activities and/or physical therapy. If you’re feeling anxious about receiving a cervical ESI, don’t be afraid to ask your healthcare provider about it and the procedure. They can answer any questions you may have.
Last reviewed on 01/25/2022.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy