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Cervical & Lumbar Injections

What are Cervical Injections?

Cervical injections are administered in a medical office or clinic setting to provide relief from pain or inflammation affecting the neck and upper back. The injection is made in the patient’s epidural space, which is the area between the outermost covering of the spinal cord, the dura mater, and the wall of the spinal canal. It runs along the length of your spinal cord, is approximately 5 mm wide and is filled with spinal nerve roots, fat, and blood vessels.

How Do Cervical Injections Work?

Cervical injections involve a mixture of an anesthetic and a steroid. By delivering an injection directly into the cervical epidural space, the medication moves freely, coating the inflamed or irritated nerve roots. The anesthetic functions by numbing the nerves to provide short or long-term pain relief, while the corticosteroids act as long-term anti-inflammatory agents, decreasing any swelling and irritation surrounding the nerves.

Indications for Cervical Injections

Cervical injections are usually employed when conservative measures, such as physical therapy or oral medications have failed to alleviate the symptoms of irritated cervical nerve roots. In-office cervical injections are indicated to treat conditions, such as:

  • Spinal stenosis
  • Bulging or herniated disc
  • Bone spurs
  • Cervical radiculitis
  • Cervical osteoarthritis
  • Failed cervical surgery (persistent pain despite surgery)
  • Other injuries to the spine

Pre-Procedure Preparation

Your doctor will review your medical history thoroughly before the procedure. You must inform your doctor about any health conditions you have such as diabetes or bleeding disorders, and about any medications you are taking, such as blood thinners, over-the-counter medications, or supplements. You may be asked to stop taking certain medicines for several days before the procedure. You will be instructed not to consume any food or drink for several hours prior to the procedure.

Procedure for Cervical Injections

Cervical injections are performed as an outpatient procedure in a clinic setting. You will lie face-down on the table. Your neck and upper back are sterilized with a cold antiseptic solution. The injection is performed using fluoroscopy (real-time x-ray imaging) or CT scans to assist the doctor in placing the needle accurately to target the pain so the patient can derive maximum benefit. An x-ray dye is used to ensure that the distribution of the injection is satisfactory. A small dressing is applied at the site of the injection to complete the procedure.

Postoperative Care

After the procedure, you will be taken to the recovery area where you will be required to stay for at least an hour. You will need to arrange for an escort to drive you home. If you have been sedated, you must not operate machinery, drive, or consume alcohol for 24 hours following the injection. You must follow all instructions on pain medications and attend follow-up appointments to monitor your progress.

Side Effects of Cervical Injections

Some of the possible side effects of cervical injections include:

  • Pain at the injection site for a couple of days
  • Fluid retention for a couple of days due to the steroids
  • Headaches in some patients
  • Risk of infection
  • Facial flushing for a couple of days
  • Menstrual periods may be affected in females due to the effect of steroids

What are Lumbar Injections?

In-office lumbar injections are steroid shots administered to you in your physician’s clinical or office setting to relieve low back pain. These shots involve injecting a local anesthetic and an anti-inflammatory steroid into the lumbar (lower back) area of your spine. Your doctor decides on the appropriate injection depending on the source of the pain in your lumbar area.

Indications for Lumbar Injections

Acute or chronic low back pain that can spread to legs is the primary indication for lumbar injections.

How to Prepare for a Lumbar Injection?

Your physician may recommend you stop taking certain medicines (if applicable) for a specific period and avoid eating or drinking for precise hours prior to the injection. You are likely to be told to have a driver who can drive you home after the injection.

How are Lumbar Injections Performed?

Regardless of the type, the injections are given under local anesthesia and performed with the help of a fluoroscope (live X-ray) to make sure the medication is delivered into the right spot.

The lumbar injections offered in the office include:

Epidural steroid injection

  • A needle is inserted in the lower back and directed toward the epidural space.
  • The steroid is injected slowly to the affected area in the epidural space.

Caudal block injection

  • A needle is inserted and directed toward the epidural space near the tail of the spinal cord.
  • The steroid is then injected slowly into the epidural space where it acts on the spinal nerves.

Facet joint injection

  • The facet joints (joints between the two vertebrae) at the lower back are anesthetized.
  • The steroid medication is injected directly into the facet joint capsules of the lower spine.

Lumbar sympathetic block injection

  • A needle is inserted into your lower back along the outside of your spine.
  • The steroid is injected into your sympathetic nerves located on both sides of your spine.

Your doctor will provide details about each procedure in the office before administering the injection.

Risks Associated with Lumbar Injections

Following are the possible risks associated with lumbar injections:

  • Infection, bleeding, nerve damage
  • Soreness at the injection site

What Precautions Should be Taken as You Recover from the Procedure?

As you recover from the procedure, you are expected to:

  • Rest for a specific period of time
  • Avoid driving or rigorous activity for a day or two

Benefits of Lumbar Injections

Lumbar injections are usually safe, non-surgical methods to help in:

  • Relieving the pain
  • Delaying or avoiding surgery
  • Boosting mental health
  • Improving the quality of life
  • Columbia University Department of Rehabilitation and Regenerative Medicine
  • American Academy of Physical Medicine and Rehabilitation
  • American Society of Regional Anesthesia and Pain Medicine
  • NewYork–Presbyterian Hospital
  • University of Michigan
  • Association of Academic Physiatrists