Cervical Epidural Injection

Screen Shot 2019-02-17 at 1.56.07 PM.png

OVERVIEW 

If you have a herniated disc or cervical spinal stenosis, you may be experiencing neck pain–numbness-tingling that radiates to your shoulder and arm/hand.  Depending on the MRI finding, this could be on one side or both sides.  A cervical epidural injection is a treatment for such symptoms.  This is an x-ray-guided procedure in which, the steroid is injected into the epidural space to help reduce inflammation and pain.  Most patients have completed a course of physical therapy and medical management prior to considering epidural injection.  You may require surgery if the combination of physical therapy and injections is not effective.

Who should avoid Epidural Steroid Injections?

  • Individuals with known allergies to local anesthetics, steroids, or contrast material

  • Patients with a local or systemic bacterial infection

  • Pregnant Patients

  • Patients with bleeding disorders

  • Patients suffering from a tumor or infection of the spine

  • Uncontrolled congestive heart failure or diabetes

  • When the risk of holding mediations (Aspirin/blood thinners) outweighs the benefit of the epidural injection 

Risk of cervical epidural injection

 This is a common spine procedure but there is an inherent risk with any medical and surgical procedure that you need to be aware of.  Following is a list of potential complications.

 

  • Immediate or delayed allergic reaction to medication used

  • Infection

  • Bleeding  (important in patients on blood thinners or aspirin)

  • Nerve/spinal cord Injury

  • Dural Puncture

  • Temporary increase in pain

  • High blood sugar levels  (important in Diabetics )

  • Transient vaginal spotting

  • Transient facial flushing

  • Vascular uptake of a particular steroid, cord ischemia, death 

 

The following are steroid side effects in patients who take them daily.  This is still relevant to Epidural steroid injection.

  • A transient decrease in immunity

  • Stomach ulcers

  • Severe arthritis of the hips

  • Avascular necrosis of joints

  • Cataracts

  • Increased appetite

  • Agitation and irritability

  • Negative effect on bone density and fractures

 

 

Prepare for your Procedure:

 

  • For our premenopausal female patients, please do a pregnancy test before the procedure.  X-rays used during procedures can seriously harm infants resulting in birth defects and miscarriage

  • Call and cancel the procedure if you have an active infection of any sort.  If you have an infection, we will cancel the procedure even if you show up

  • You may ask you to hold certain medications to avoid bleeding.  The decision to discontinue or hold medications should be shared between the spine specialist, patient, and prescribing physician (usually PCP, cardiologist, or neurologist). Do not hold medication unless we instructed you to do so.  Your primary care and cardiologist should authorize this medication hold first.   IF YOU HAVE ANY QUESTIONS REGARDING THESE INSTRUCTIONS CALL 617 547 7163

 

  1. Aggrenox® (dipyridamole)

  2. Aspirin

  3. Coumadin® (warfarin)

  4. Effient® (prasugrel)

  5. Fragmin® (dalteparin)

  6. NSAIDs (see complete list  below )

  7. Herbal blood-thinners

  8. Heparin

  9. Eliquis ® (apixaban).

  10. Lovenox® (enoxaparin)

  11. Plavix® (clopidogrel),

  12. Pradaxa® (dabigatran)

  13. Ticlid® (ticlopidine)  

  14. Examples of NSAIDs to be held: Ibuprofen, Motrin, Naproxen, Advil, Nabumetone, Diclofenac, Etodolac, Indomethacin, Ketorolac, Meloxicam, Piroxicam, Ketoprofen, Oxaprozin

Day of your procedure 

 

1.  Take a shower, and wash your skin with simple soap.  Do not put lotion on your back.  Wear loose dark clothing.
2.  Arrive 30 minutes early.  You will be here for an hour
3.  Bring your MRI CD and updated list of medications/allergies with you
4.  Do not eat 2 hours before injection.  Diabetics should eat a light meal.
5.  Unless instructed otherwise, take all your normal medications with a sip of water.
6.  We will place an IV if this is your first cervical epidural injection.
7.  If we prescribe sedatives, take them 1 hour before the procedure.  Don't drive or make important life decisions on this medication.

During the procedure

 

  • You will change into a gown.  Nurses will go over your medication and allergies for the procedure.  You may receive an IV. 

  • In the procedure room, we will attach monitors for blood pressure and heart rate.  Medical devices make lots of noise.  You should not be concerned. Intermittently your doctor will talk to staff in the procedure room and instruct them to perform a task. Your physician will guide you step by step through the procedure.

  • After standard time out, your skin will be disinfected with a cool solution, and a sterile sheet of paper or plastic will be placed on your skin. When your physician is ready, an X-ray unit is placed over your spine to identify the target. Skin will be marked and anesthetized (you will feel a small pinch and burning sensation at each spot). It is normal to feel pressure or muscles twitching as needles are advanced to the final target. Once the needle is at the radiographic target, a small amount of contrast is injected to confirm the final needle position before injecting steroid medication. You may feel transient pressure in your spine or arm. Once the procedure is completed, the needle is removed, the skin is cleaned and a bandage is applied. You are then transferred back to the recovery area for observation.

Right after the procedure

 

  • You will be observed for 15-45 minutes.

  • If you have an IV line, it will be removed.

  • A nurse will check your vitals, review the discharge instructions with you, and answer any questions you may have. A responsible adult must be present to drive you home after discharge.

  • You will leave with a pain log and a copy of the discharge instruction which contains Emergency contact numbers. Please do not discard your discharge instructions.

  • A responsible adult must drive you home.

 

Discharge instructions

 

  • Make a follow-up appointment in 2-3 weeks.

  • You may resume your normal diet and medications after the procedure.

  • For 12 hours after the procedure, do not drive or operate machinery

  • If oral sedation is used,  do not make financial or important life decisions for 24 hrs 

  • For 24 hours after the procedure, do not participate in strenuous activity or submerge under water. OK to shower 

  • Resume anticoagulants 12 hours after the procedure. If you are on Coumadin, you may need to check INR in 2- 3 days.

  • Diabetics should monitor blood sugar levels 3 times a day for 3 days after the procedure.  

 

You may be directed to ER

 

  • Shortness of breath or palpitation after the procedure

  • excessive redness or signs of infection like warmth, discharge, or collection of pus at the site of injection

  • Sudden weakness

  • Fever over 101°F within 5 days after the procedure

  • Persistent redness, increased localized pain, or discharge from the site of injection.

  • Possible allergic reaction within 5 days of the procedure

  • Intractable headache

  • Significantly increased pain not responding to ice, NSAIDs, and pain meds or associated with fever

  • Newly developed weakness in the legs, face, or arm following procedure

  • Newly developed incontinence of urine or stool following procedure

 

INSURANCE COVERAGE

  • If your insurance requires authorization, we will get it automatically. It takes 3-15 business days to hear back from insurance.

  • Most patients have co-pays and deductibles.  We collect these at the time of service.

  • You will receive two medical bills for this procedure.

    • one is from New England spine Care Associates

    • one is from New England Ambulatory surgical center.

 

 

Screen Shot 2019-02-17 at 1.52.28 PM.png
Screen Shot 2019-02-17 at 1.52.41 PM.png
Screen Shot 2019-02-17 at 1.52.54 PM.png