Cervical epidural steroid injection [Neurosurgery Wiki]

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====== Cervical epidural steroid injection ======

There is good evidence for the effectiveness of cervical interlaminar epidural injections in managing cervical disc herniation 
((Manchikanti L, Falco FJ, Diwan S, Hirsch JA, Smith HS. Cervical radicular
pain: the role of interlaminar and transforaminal epidural injections. Curr Pain 
Headache Rep. 2014 Jan;18(1):389. doi: 10.1007/s11916-013-0389-9. PubMed PMID:
24338702.)).
----


Cervical [[epidural steroid injection]]s (CESI) are an accepted treatment for [[neck pain]] with a radicular component, and may be accomplished by using either [[Cervical interlaminar epidural steroid injection]] or
[[Transforaminal cervical epidural steroid injection]] approaches. CESIs are routinely performed using real-time fluoroscopic-guidance in conjunction with the injection of water soluble, iodine-based contrast media to enhance visualization of intravascular injections. Digital subtraction angiography (DSA) imaging is an adjuvant to fluoroscopic methods for visualizing blood vessels while performing spinal injections
((Candido KD, Knezevic N'. Cervical epidural steroid injections for the treatment of cervical spinal (neck) pain. Curr Pain Headache Rep. 2013 Feb;17(2):314. doi: 10.1007/s11916-012-0314-7. PMID: 23315021.)).



===== Types =====


[[Cervical interlaminar epidural steroid injection]]

[[Transforaminal cervical epidural steroid injection]]

===== Complications =====


see [[Cervical Epidural Steroid Injection Complication]]



====Case reports====
Here, we report the case of a 54-year-old man with cervical radicular pain who was treated with cervical epidural steroid injection. Injection was administered twice under fluoroscopic guidance with the loss-of-resistance technique using air to confirm the epidural space. After the second procedure, the patient complained of severe persistent headache and was diagnosed with pneumocephalus on brain computed tomography. The patient returned home without any neurological complication, after a few days of conservative treatment. Though, a fluoroscopic guidance cervical epidural injection is also known to diminish the risk of complications. Physicians should always keep in mind that it does not guarantee safety, particularly in the cervical region, related to its anatomical considerations.