The spinal nerves and cord carry feeling impulses from the body up to the brain and impulses from the brain down to the muscles.
What is a cervical epidural?
The neck area of the backbone is called the cervical spine. Epidural injections into this area, the upper spine, are used to treat a number of different painful conditions. The condition most often treated is pain in the arm, called brachalgia. This is a condition similar to sciatica, which affects the leg. Sciatica is caused when problems in the spine cause pain to radiate down the leg. Similarly, with brachalgia, problems in the upper spine can cause pain to radiate down the arm.
The injection is usually given into your upper spine from the back. The needle is inserted between the gaps of the backbones (vertebrae), into an area known as the epidural space. This is a space that surrounds the spinal cord. The nerves that carry painful sensations pass through this space. The injection is just outside the covering of the spinal cord, which is called the dura; hence the name epidural.
An epidural injection can target the painful area. The injection bathes the nerves and intervertebral discs in local anaesthetic and steroid solution. Only a small amount of steroid is needed and it will not cause any of the side effects sometimes associated with taking steroid tablets. They are not the same kind of steroids that athletes may take. This steroid injection relieves pain and inflammation. Arm pain, caused by inflamed nerves in the spine, can be treated in this way. Bathing inflamed discs in this way may also reduce some neck pain.
What has gone wrong?
You have suffered damage from injury, or general wear and tear (degeneration) to the intervertebral discs in the spine. The disc becomes inflamed and causes the nearby nerves to become irritated. Because the irritated nerves supply sensation to the arm, the brain can be fooled into believing that the arm is injured. This is not the case; even though pain may affect the arm the problem is in the spine.
The aim of the procedure is to reduce the inflammation of the intervertebral disc. This will relieve your arm pain and some of your neck pain.
Your pain should be reduced and you should be able to move around more easily. You can then exercise to prevent the problem happening again. If successful, this treatment can avoid the need for surgery.
Are there any alternatives?
By the time you consider a cervical epidural you should have already tried other more simple treatments. These include rest, painkilling and anti-inflammatory tablets, and physiotherapy with exercise.
You may also have tried a transcutaneous electrical nerve stimulation (TENS) machine for your pain. This works by sending soothing pulses across the surface of the skin and along the nerve fibres. These pulses prevent pain signals from reaching the brain. They also stimulate your body to produce higher levels of its own natural painkillers, called endorphins.
What if you do nothing?
If you do nothing there are several things that may happen:
With time and rest the inflammation and pain may settle on its own
The pain and difficulty in moving around may stay the same
The pain may increase
The disc may become more damaged and may injure the nerves that control movement. You may then develop weakness and difficulty in moving your arms. Some of this may be permanent
In severe cases you may also lose control of your legs, and even your bladder and bowels, as the nerves that control these are damaged.
Who should have it done?
The following groups of patients should have the procedure done:
Who should not have it done?
Each patient has the final decision as to whether to proceed or not. If you are unhappy about the procedure for any reason you should not continue.
There are specific medical situations when an epidural should not be done and they are as follows:
When a patient is on medication that prevents blood from clotting, such as warfarin. This would lead to more bleeding than normal. It may be possible to stop the medication a few days before the procedure. This will need to be discussed with your doctor
When a patient is suffering from an illness that prevents blood from clotting, such as haemophilia. This would also lead to more bleeding than normal
When there is infection of the skin over the site where the needle needs to be put in
When the patient has a bloodstream infection
When a patient has noticed a recent worsening of their symptoms, especially weakness and loss of bladder or bowel control
Author: Dr Sean White FRCA. Consultant in pain and anaesthesia.
© Dumas Ltd 2006