For Neck & Arm Pain
What is the epidural space?
The dura is a protective covering of the spinal cord and its nerves. The space surrounding the dura is called the epidural space. In the neck it is called the cervical epidural space.
What causes pain in the epidural space?
The cervical area of the spine has seven bones, called vertebrae. Soft discs found between these vertebrae cushion them, hold them together, and control motion.
If a disc tears, chemicals inside may leak out. This can inflame nerve roots or the dura, and cause pain.
A large disc tear may cause a disc to bulge, inflaming or compressing nerve roots, inflaming the dura, causing pain. Bone spurs, called osteophytes, can also press against nerve roots and cause pain.
How do I know if I have disc and nerve root pain?
If you have pain in your neck or upper back when you move your head or neck, you may have cervical disc and dural inflammation. If pain travels to your arm when you move your head or neck, you may have nerve root inflammation.
Common tests such as MRIs can show disc bulges and nerve root compression, but may not show a torn and leaking disc. A cervical epidural injection may provide relief if disc problems, or dural, or nerve root inflammation are causing your pain.
What is a selective nerve root block?
In a selective nerve root block, local anesthetic is injected around a cervical nere root. It puts medication directly along an inflamed nerve root. A selective nerve root block can determine if a specific nerve is causing your pain.
What happens during an injection?
A local anesthetic will be used to numb your skin. The doctor will then insert a small needle next to the nerve root. Fluoroscopy, a type of x-ray, must be used to ensure the safe and proper position of the needle. Dye will also be injected to make sure the needle is at the correct spot.
Once the doctor is sure the needle is correctly placed, the medicine will be injected.
What happens after an injection?
You will be monitored for up to 30 minutes after the injection. When you are ready to leave, the staff will give you discharge instructions. You will also be given a pain diary. It is important to fill this out because it helps your doctor know how the injection is working.
It will help to move your neck and arm in ways that hurt before the injection, to see if the pain is still there, but do not overdo it. Take it easy for the rest of the day.
You may feel immediate pain relief and numbness in your neck and arm for a period of time after the injection. This tells you the medication has reached the right spot.
Your pain may return after this short pain-free period, or may even be a little worse for a day or two. It may be caused by needle irritation.
You can usually return to work the day after the injection, but always check with your doctor.
How long can I expect pain relief?
A cervical selective nerve root block will only work for a few hours. It is a diagnostic test only. It is important to relay the amount of pain relief and duration of relief to your doctor or the doctor that referred you.
This pamphlet is for general education only. Specific questions or concerns should always be directed to your doctor. Your doctor can explain possible risks or side effects.