Are There Risks To Having a Cervical Epidural Injection?

Question: I have a herniated disc at C-7/T-1 causing pain at the site of the herniation and numbness down my left arm and into my hand. Is an epidural steroid injection proper treatment for a herniated disc this high up on the back and close to the brain? I've only heard of injections being used for lumbar spine injuries.
—Beebeetown, IA

Answer: This is a fascinating question. Epidural injections are often used to treat lumbar (low back) herniated discs, but using them for cervical herniated discs can pose concerns. Yes, there are complications associated with injections in the neck. And even though these risks are very rare, it's still important that patients understand what they are.

First, the reason why you've only heard of lumbar epidural steroid injections is likely because an overwhelming majority of epidural injections—approximately 90%—are performed in the lumbar spine.

Another possible reason why lumbar injections are more common than cervical injections is that there are more doctors willing to give lumbar injections. There are many types of doctors who can administer epidural injections, including neurologists, anesthesiologists, and orthopedic surgeons, but not all feel comfortable giving cervical epidural injections. This is because the possible complications are greater than those associated with lumbar injections.

These complications include:

• Hematoma: Epidural hematomas (which are semisolid masses of blood) can compress the spinal cord. This risk is increased when numerous attempts are made with the needle to find the epidural space. Fortunately, hematomas caused by cervical injections are highly unusual.
• Spinal cord injury: When you inject into the epidural space in the lumbar spine, it's below the spinal cord (the spinal cord ends at L1, and you can read more about the spine's nerve structure here). With a cervical injection, on the other hand, you're injecting next to the spinal cord. If the needle goes too far, you can damage the spinal cord and also cause a spinal fluid leak. The former can result in paralysis, the latter can cause severe headaches, among many other possible problems. But as with hematomas, these are very rare complications.

Cervical injections are performed using fluoroscopy—a live x-ray that helps doctor precisely maneuver instruments. This certainly helps reduce the risk of complications, but fluoroscopy alone won't always prevent problems.

If cervical epidural injections are a treatment option for you, you should consult a doctor who administers cervical epidural injections exclusively—or at the very least, on a regular basis. Choosing a doctor who is familiar and comfortable with cervical epidural injections is your best defense against any of the risks I mention above.

If you're unsure whether cervical injections are right for you, talk to your doctor about other treatment options. Oral steroids, for instance, are a common alternative.

But in the hands of someone who administers them regularly, cervical epidural injections can be a safe and effective non-surgical treatment for your cervical herniated disc.