Cervical epidural steroid injections are treatments intended to relieve pain in the upper body and arms caused by pinched or inflamed nerves in the cervical spine. This type of injury can have a drastic impact on a person’s quality of life, especially as the structures of the spine degenerate.
Though steroidal injections have been shown to have a positive impact on the management of nerve-related pain, treatment methods, success rates, and risks vary so largely that patients would be wise to do their research before applying such treatments.
In this article, we will discuss the research behind cervical epidural steroid injections as they apply to pinched and inflamed nerves.
Often referred to as cervical radiculopathy, pinched nerves in the cervical spine may occur due to several inciting factors. Chronic illnesses such as arthritis and spinal stenosis, acute injuries, and “wear and tear” issues such as disc herniation can all lead to some level of cervical radiculopathy.
As the issues intensify, the structural integrity of the cervical spine begins to collapse, putting undue pressure on the nerves in the neck. Unfortunately, nerves do not respond well to the added stress and eventually the pressure on the pinched nerves causes inflammation and pain which radiates throughout the upper back and along the arms. These issues can also be accompanied by muscle weakness, numbness, and limited range of motion.
Though these issues may cause quite a disruption in a person’s daily life, cervical radiculopathy tends to respond well to conservative treatments. One of the most popular of these conservative treatments is a procedure known as a cervical epidural steroid injection.
Though there are many ways to treat cervical radiculopathy, one of the most popular in recent years has been cervical epidural steroid injections.
What are Cervical Epidural Steroid Injections?
Cervical epidural steroid injections are a series of shots administered into the tissues surrounding the cervical spine. These shots aim to help manage the pain caused by cervical radiculopathy by decreasing the inflammation levels of the pinched nerves.
Corticosteroids, often referred to simply as steroids, are the active ingredient in many steroidal injection therapies, including cervical epidural steroid injections. These steroids are lab-developed drugs made to closely resemble cortisol – a hormone the body naturally produces to help respond to stress.
While there are many types of corticosteroids (cortisone, prednisone, and methylprednisolone), the most commonly used in instances of cervical radiculopathy is cortisone, though depending on the severity of a patient’s symptoms, one or multiple steroids may be administered at the time of visit.
Cervical epidural steroid injections are typically outpatient procedures, taking less than 30 minutes to administer. Initial side effects are mild and may take 2-3 days to clear before the drugs take effect. Patients often report relief lasting anywhere from 2 weeks to several months.
Cervical epidural steroid injections, just like most steroidal treatments, must be administered periodically as symptoms manifest in patients. Though initial side effects are mild, prolonged use of steroids can have several adverse consequences. As such, most health organizations recommend limiting the total number of injections to 3 to 4 per year.
How Do Cervical Epidural Steroid Injections Work?
Though there are many types of steroid which may be injected at the time of the procedure, the most commonly applied steroid for inflamed nerves in the cervical spine is cortisone.
Though it may be used to treat the pain caused by pinched nerves, cortisone itself is not a pain medication. Instead, cortisone actively works to reduce inflammation by blocking collagen production.
The injections shut down collagen-producing cells in the joints of the neck thereby suppressing inflammation and calming nerves, indirectly alleviating the pain this inflammation causes. Therefore, the injections do not address the underlying issues causing the pain, but instead, treat one of the symptoms these issues create.
Because each patient applies the treatment at different points in the development of their pinched nerve, the relief due to cervical epidural steroid injections has different time frames for each person. Some patients report immediate relief, while for others, relief may take time. If the cervical radiculopathy is severe or if it is due to a chronic issue, relief may not be adequate or may never come.
How Successful are Cervical Epidural Steroid Injections?
Success rates for cervical epidural steroid injections are largely subjective, though the main factor patients consider in their success is pain relief and management. Several studies have been conducted to quantify the efficacy of these treatments, with varying results.
One study by the Journal of Spinal Disorders and Techniques in 2006, followed 70 patients through their cervical epidural steroid procedure. Of these 70 patients, 44 (63%) found prolonged relief from their cervical radiculopathy, enough to reconsider surgical intervention.
In another study conducted for the Humana Press, only 38% of those treated found any relief whatsoever after administering cervical epidural steroid injections for their pain.
Additionally, studies have been conducted to interpret the efficacy of the application location for such steroids. One study by the Journal of Clinical and Diagnostic Research found that transforaminal injections worked best, while another by the Korean Journal of Pain found caudal injections to work the best.
Though some pain-relieving results have been noted by patients and clinics alike, there is simply not enough clinical data to support using cervical epidural steroid injections as a way to manage pain caused by pinched nerves. The FDA has even released several statements disparaging the efficacy of steroidal injections for pain management, citing their use as a major causal factor for “serious neurologic adverse events.”
Though pain relief using steroidal injections may be possible for some, most data supports that prolonged use of such treatments can cause worse issues to manifest in any patient using such treatments.
What are the Risks of Cervical Epidural Steroid Injections?
As with any medicine, risks exist when applying cervical epidural steroid injections. While doctors and clinical specialists can offer some guidance, it is ultimately up to the patient to decide if these risks outweigh the benefits when choosing to apply steroids to their issue.
Fortunately, steroids have been used as a treatment for nerve pain for several decades, so there is plenty of clinical data to look towards when weighing the risks. Some of the more researched and proven side-effects of steroidal injections include:
- Spinal cord, brain, and nerve injury
- Weakened bone and muscle structures
Less severe, but more likely reactions include:
- Skin thinning
- High blood sugar
Infection due to steroidal injection is fairly uncommon, though not completely absent. In an article posted by the Center for Disease Control in 2012, the organization discovered an outbreak of a deadly strain of meningitis that traced back to three lots of steroid solutions made in Massachusetts.
A month after the article was posted, the FDA had identified 137 cases of the outbreak with 12 confirmed deaths in 10 states due to the bad batch of steroids.
Furthermore, a study by Deutsches Ärzteblatt International, the official journal of the German Medical Association and the National Association of Statutory Health Insurance Physicians, found that “repeated injections with too little time between them raise the risk of infection.” In the study, DA International found that of 1528 cases examined, 223 (15%) were found to have suffered an infection tracing back to their use of steroidal injection.
Spinal Cord, Brain, and Nerve Injury
In a study of claims filed by 35 US liability insurance companies published by Anesthesiology, the journal found that some of the most common claim-related incidences involved “direct needle trauma to a nerve or the spinal cord” and “cord infarction/stroke after intraarterial injection”. Together, these incidents accounted for 45% of insurance claims involved in cervical procedures.
In another study published by Regional Anesthesia & Pain Medicine, they editorial utilized anonymous surveys sent to all US physician members of the American Pain Society. Of the 287 respondents, 78 claims of the spinal cord, brain, and nerve injury were reported, with 13 fatalities between them.
Weakened Bone and Muscle Structures
One of the most studied and generally accepted risks of repeated steroid use is weakened bone and muscle structure. Many studies have confirmed that bone mineral density decreases with repeated steroid use and that these treatments significantly increase the chances of a person developing osteoporosis and osteopenia. These weakened bone structures were also linked to increased risk of bone fracture according to one study.
What Alternatives Exist for Nerve-Related Pain?
While cervical epidural steroid injections are still a fairly common treatment throughout the US, the risks included may be enough to dissuade potential patients from attempting such treatments. Furthermore, other conservative treatment options (physical therapy and over-the-counter medication) may not provide enough relief from inflamed or pinched nerves to satisfy some patients.
While surgery may seem like all a patient is left with, this may not be the case due to recent advancements in the field of regenerative medicine.
Regenerative Medicine and Nerve Pain
While steroidal injections may relieve the pain caused by inflamed and pinched nerves, the underlying issue persists and may get worse over time due to the characteristics of steroids. Regenerative therapies offer a solution to these problems by treating both the symptoms of inflamed nerves and their inciting factors.
Furthermore, stem cell and platelet rich plasma (PRP) injections such as those offered at CELLAXYS, do away with many of the potential risks of steroid injections as the source materials come directly from the patients and are administered using state of the art application technologies.
By harvesting and processing tissues such as blood, fat, and bone marrow, directly from the patient, they will be put back into, the doctors at CELLAXYS can create treatments which induce and amplify the body’s own healing responses.
Platelet Rich Plasma derived from the blood of our patients is a mixture of the plasma found in the blood and natural growth factors developed by our partners. Just like our PRP, CELLAXYS stem cell solutions are created from either bone marrow or blood derived from the patient which has been processed and mixed with growth factors.
By applying these mixtures via X-ray guided injection, our doctors can ensure the treatments reach the locations where they will be most effective.
Much like steroidal injections, once inside the body, these treatments reduce inflammation by sending out chemical impulses which dull the body’s natural response to stress. However, unlike steroids, these injections do not limit collagen production or limit the body’s other healing responses, and thus do not deplete the resources necessary to keep the bone and muscle structures intact.
Over time, stem cell injections have even been shown to replenish soft tissue stores, thereby “re-cushioning” the spinal structure and treating one of the inciting factors of pinched nerves.
While steroidal injections may provide immediate relief in some patients, the potential risks may outweigh any benefit a patient is hoping to experience. Several studies have confirmed the risks cervical epidural steroid injections carry and many more have ousted these treatments as ineffective with prolonged use.
For those seeking an alternative, equally conservative form of treatment, perhaps regenerative medicines are the answer. If you would like to learn more about how regenerative therapies can help treat your nerve pain, contact the CELLAXYS offices today to set up a consultation.