First of all, it may help to define some terms:
- Cervical, in this context, refers to the neck.
- Epidural refers to the space around the dura, a sac around the roots of nerves that contains cerebrospinal fluid.
- The nerves from the neck extend through the epidural space before descending down into the shoulders and into the arms and hands.
Injection into this space delivers medication directly to coat the nerves in the area. A number of cervical spine conditions can affect the nerves as they exit the spine through small holes on each side of each of the vertebrae. Injections into the epidural spine relieve symptoms without the need of surgery to repair the underlying condition.
For example, a herniated disk of the spine can press against the root of a nerve. Removing or repairing a herniated disk requires a surgical procedure. Operations of this kind are a lot less complicated than they used to be, but it is always best to avoid any kind of surgery involving the central nervous system. A cervical epidural injection can deliver anesthetic to the nerve root, relieving pain without relieving pressure on the root caused by the herniated disk. This doesn't cure the condition, but it relieves pain.
In a cervical epidural injection, the patient lies face down. An area of skin and tissue over the spine is injected with a local anesthetic to block the pain of the procedure. Then a larger needle is inserted into the epidural space itself. The doctor uses a technique called fluoroscopy to see where the needle is going. The doctor injects contrast dye into the epidural space to make sure the needle is properly placed into the epidural space near the irritated nerve or nerves. A sterile solution including lidocaine (an anesthetic) or lidocaine plus cortisone is injected into the epidural space (or very similar drugs, betamethasone may be used instead of cortisone). The anesthetic or the anesthetic plus steroid relieves local inflammation, which should in turn reduce the associated nerve pain.
The objective of a cervical epidural injection is usually to provide enough pain relief that the patient can progress with a rehabilitation program. The injection itself is only part of treatment. The rehabilitation program is essential.
Sometimes the doctor will administer a sedative in addition to the local anesthetic, especially if the patient is particularly anxious about the procedure. Most people feel no pain during an epidural injection. Complications are very rare. They occur in fewer than 1 in 1,000 cases (in the United States, about 1 in 2,500 cases), although misplacement of the needle can cause severe, permanent problems and in very, very rare cases, even death. Usually the problem arises from sudden movement by the patient during the procedure. Preventing sudden movement is the reason many doctors also give their patients sedation.
The steroids used in epidural injection don't always cause weight gain. Only about 18 percent of patients who get an anesthetic plus a steroid gain weight in the two years after the procedure. Weight gain is actually more common in patients who don't get a steroid, just an anesthetic, probably because the procedure does result in as much pain relief and the patient isn't as able to exercise. However, if you are in that 18 percent of patients who gain weight after getting steroids, it helps to:
- Reduce salt intake. Steroids cause your body to accumulate sodium, which it dilutes with water.
- Reduce carbohydrate intake. The way the body uses insulin also causes it to accumulate sodium, which causes additional water weight.
- As much as you can, exercise. Pain-free activity helps you lose the pounds.
Don't worry about damage to your thyroid and hypothalamus. It's not utterly impossible, but the problem would be from the shot the doctor gives you block the pain involved with the needle that goes into your spine, not from the epidural itself.
Do expect pain relief, but not perfect pain relief. You'll likely need the procedure again in two years, and you won't make progress if you can't do the exercises needed for rehabilitation.
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