Cervical Epidural Steroid Injection: Techniques and Evidence

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Key points

  • Cervical epidural steroid injections are a common interventional treatment of cervical radicular pain.

  • The differing neurovascular anatomy in proximity to the route of entry for transforaminal and interlaminar epidural steroid injections must be thoroughly understood to perform safe injections.

  • Use of particulate steroid and mixture with certain local anesthetics may pose increased risk for spinal cord ischemia during transforaminal epidural injection, in which inadvertent arterial injection is

Anatomy

A thorough understanding of cervical anatomy with particular attention to neurovascular structures is essential for the safe performance of cervical TFESI. One anterior spinal artery and 2 posterior spinal arteries provide penetrating branches that supply the cervical spinal cord. These arteries arise from radicular and spinal medullary arteries, which originate from the ascending cervical, deep cervical, and vertebral arteries. The spinal and radicular medullary arteries traverse the cervical

Anatomy

A thorough understanding of cervical anatomy, unique to the dorsal epidural space and posterior elements, is crucial for safe cervical IESI. Significant differences in the vasculature and the width of the dorsal epidural space compared with the characteristics of these structures in the ventral epidural space result in alternative risks and considerations during cervical IESI as opposed to TFESI. First, unlike the neuroforaminal space, there is minimal to no arterial vasculature in the dorsal

Summary

Cervical ESIs are among the most common interventional pain procedures performed for radicular pain. Important safety considerations include attention to the possibility of spinal cord infarction and spinal epidural hematoma. When appropriate radiographic, technical, and pharmacologic principals are used, these procedures are relatively safe. Cervical ESIs provide fairly effective short-term treatment effect. Long-term outcomes, however, are less certain. The evidence base for cervical ESIs is

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