Introduction

Cervical transforaminal epidural steroid injections are a non-surgical option to ease pain in the neck, shoulder and upper extremity.  The neck is a vulnerable part of the spine and is susceptible to injury and degeneration.  A variety of conditions can cause pinched nerves in the neck, which not only can cause pain in the neck, but pain that spreads to the shoulders and arms.  Cervical transforaminal epidural steroid injections deliver medication directly to the affected area, and can be used as a diagnostic tool and as a treatment modality.

Anatomy

The cervical area of your spine is located in your neck.  Seven small bones (vertebrae) make up the cervical spine.  A disc between each bone allows movement, provides stability, and acts as a shock absorber. The opening in the center of each bone forms the spinal canal.

Your spinal cord is located within the protective spinal canal.  The spinal cord extends from the brain and is a major part of your nervous system.  The spinal cord does not fill the entire space in the spinal canal.  Instead, the spinal cord is surrounded by the epidural space (cavity), which contains tissue, nerves, and blood vessels.

Spinal nerves extending from the spinal cord travel out of openings or “tunnels” in the bones (foramina) to exchange nerve signals with your brain about specific parts of your body.  The eight nerves at the cervical level control body functions and sensation for your head and neck, the muscles used for breathing (diaphragm), shoulder and upper arm muscles, and the muscles that control the wrists and hands.

Causes

Cervical transforaminal epidural steroid injections are used to relieve pain from pinched nerves in the neck.  Ruptured (herniated) discs and spinal nerve root diseases (radiculopathy) can contribute to pinched or compressed nerves. Another possible cause, spinal stenosis, is a condition that causes the spinal canal to narrow and put pressure on the spinal cord and nerves.

Symptoms

The symptoms that you experience depend on the cause of your neck pain.  Pinched nerves in the cervical spine can cause neck pain, tingling, and numbness that radiates to the shoulders, arms, and  hands.  The pain may become worse when you move your neck, cough, or laugh.  Your neck muscles may spasm.  Your arms or hands may feel weak.

Diagnosis

Your doctor will examine you and conduct tests to determine the cause of your neck pain.  Imaging tests, lab tests, and nerve studies may be used to provide your doctor with more information.  Your doctor will let you know if cervical transforaminal epidural injections are a treatment option for you.

Treatment

Cervical transforaminal epidural injections are used to place local anesthetics and/or corticosteroids directly near the source of pain and inflammation.  The medication is injected in the foramen “tunnel” that the nerve travels through from the spine.  Steroid medication is used to reduce inflammation and relieve pain.

Cervical transforaminal epidural steroid injections are short outpatient procedures that can be received at a surgery center, hospital, or your doctor’s clinic.  You will wear a gown for the procedure.  You will be positioned sitting up or lying down.  Before you receive the epidural injection, the back of your neck will be sterilized and numbed with an anesthetic. You may receive relaxation medicine before your procedure.

Your doctor will use a live X-ray image (fluoroscopy) to carefully insert and guide the needle to the foramen “tunnel” of the affected nerve.  A contrast dye is used to confirm the needle placement.  Next, the medication solution is delivered, and the needle is removed.

You will be monitored for several minutes before you can return home.  Your doctor will instruct you on how to relieve temporary mild pain at the injection site.  It is possible to experience relief with just one injection; however, repeated injections may be necessary.