Cervical Epidural Injections

Chronic neck pain with or without upper extremity pain or headaches is relatively common in the adult population secondary to disc herniation, discogenic pain, spinal stenosis, spondylosis, and post-surgery syndrome. Treatments for chronic neck pain, recalcitrant to conservative management resulting in disability, include surgical management as well as interventional techniques with epidural injections utilizing either an interlaminar approach or transforaminal approach. There have been multiple systematic reviews and clinical trials of efficacy and effectiveness of cervical interlaminar epidural injections. However, the literature continues to be sparse in reference to cervical transforaminal epidural injections. In addition, cervical transforaminal epidural injections have been associated with an inordinate risk. Overall, there is Level II evidence of efficacy and effectiveness of cervical interlaminar epidurals in managing neck pain with or without upper extremity pain with cervical disc herniation or radiculitis, discogenic pain, central spinal stenosis, and cervical post-surgery syndrome. However, the evidence of effectiveness is less favorable with Level III to IV with substantially higher risk for cervical transforaminal epidural injections in disc herniation.