Cervical Epidural Steroid Injections – Transforaminal

AKA: Selective nerve root injection
Cervical: Neck
Epidural: Place where medication is injected (just outside where your nerves are located)
Steroid: Strong anti-inflammatory
Frequency: Up to 6 times/year (1/2 dose of what is used during an cervical interlaminar epidural)
Transformanimal: Across the foramen (ie where the nerve is leaving your spine)
Anesthetic: Local

Indications:  Pain typically comes from nerves that become irritated and subsequently swollen (inflamed).  By placing a steroid, which is a strong Anti-inflammatory, on the specific nerve(s) that is irritated, this decreases the swelling around this nerve which decreases your pain.  This procedure targets a specific nerve that may be causing your pain which has the potential of not only giving you pain relief but also determining a specific diagnosis for your pain.  This is considered a “sniper” approach to pain relief in your neck and shoulder/arm.  The patients who typically benefit the most from this procedure have neck pain that radiates down one or both shoulders to the arms in a specific pathway.   Some patients who complain of shoulder pain may actually have neck pathology causing these symptoms.  Some indications include:

Herniated/bulging discs that are pressing on a specific nerve in your neck
Acute/Chronic neck pain usually associated with arm pain
Continued pain after neck surgery
Cervical degenerative disc disease with possibly a tear in the disc

Contraindications/Reasons why you may not have your injection today:

Bleeding disorders/low platelet counts
Medications that thin your blood (please review this section)
Current infection
No driver
Your symptoms have changed and/or improved
Patient refusal
Procedure not approved by your insurance
Poorly controlled high blood pressure that may be giving you symptoms
Poorly controlled diabetes
Certain types of glaucoma
Poorly controlled bipolar disorder
Allergies to the any of the medications that is being used

Potential side effects/risks of the procedure:

Increased pain
Numbness in upper extremities that is short lived
Infection
Bleeding
Allergic reaction
Cramping in extremities
Mood changes
Flushed face/extremities
Headaches
Worsening of high blood pressure
Increasing of blood sugars if you have diabetes
Water retention
Chronic steroids can cause weight gain
Seizures
Stroke
Nerve and/or spinal cord injury

Procedure: 
During the procedure, you will be lying on your back.  An x-ray machine is used to locate the specific level of the spine which is believed to be causing your pain.  After your skin is cleaned with an antiseptic solution, typically betadine unless you are allergic, a series of x-rays will be taken to guide the needle placement.  The skin is localized with a local anesthetic which is typically the most painful part of the procedure as this medicine has a tendency to burn when it is injected.  After this point, you should only feel pressure.  If anything is too painful for you, please tell your physician as more numbing medicine can be given at any time.  When the needle approaches the nerve, contrast/dye is injected to confirm that the needle tip is next to the nerve and not in a blood vessel and/or in the spinal fluid space.  This is also confirmed by injected a small dose of local anesthetic.  Next, a steroid solution is slowly injected.  You may experience pressure/a warming sensation/increased pain down the arm that is hurting you.  That is to be expected.  However, if at any time the pain is too intense, please tell your physician to slow down your injection.  After the medication is injected, the needle is removed and the procedure is completed.

Typical length of the procedure: 
5 minutes.  Expect to be at the clinic no more than 15 minutes after you have been checked in by the medical assistant into the preoperative area.  If this is your first time at our clinic, you will likely be at the clinic for at least one hour.  Please plan accordingly.

How long do you expect pain relief: 
It is difficult to determine how long and how much pain relief you may experience.  It varies depending on multiple factors.  Some patients do not gain any relief from the procedure and some may have permanent relief.  If you experience relief right after this procedure, this can be diagnostic that your pain is coming from the specific nerve(s) that was injected today.