Cervical Epidural Injection

A cervical epidural steroid injection calms swelling and eases long-term neck pain. It also relieves nerve pain that spreads down the arm. Guided by live X-ray at Remix Medical in Houston, TX.

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By Raju Mantena, DO · Pain Medicine PhysicianReviewed Jan 19, 20242 min read

Key takeaways

A cervical epidural steroid injection delivers anti-inflammatory medication into the epidural space of the neck under live fluoroscopic guidance — nothing is injected into the spinal cord itself.
It's mainly used for cervical radiculopathy (shooting arm pain from a pinched nerve) and chronic neck pain that hasn't responded to conservative care.
Evidence indicates epidural steroids probably reduce short-term pain and disability in cervical radiculopathy, with multiple injections generally more effective than a single one; long-term benefit is less certain.
Fluoroscopic guidance with contrast confirmation is standard and makes serious complications rare, with the interlaminar approach typically performed at the C7-T1 level where the space is largest.
It's not a cure but reduces inflammation enough to enable physical therapy and recovery, with steroid exposure usually limited to about three injections in six months.

What is a Cervical Epidural Injection?

A cervical epidural injection (CESI) is similar to what is administered to women in labor. Also referred to as a cervical epidural steroid injection, the procedure is safe and effective in treating neck and back pain. Anti-inflammatory medicine is injected into the epidural space near the spine — nothing goes on or into your spine. You will experience reduced swelling, inflammation, and pain.

Often Used to Treat

CESIs are often used to treat:

Spinal stenosis
Headaches
Chronic neck pain
Cervical radiculopathy — shooting pain from the neck into the arms, shoulders, or fingers, often described as pins and needles. This often occurs due to a disc herniation, causing a nerve to be compressed and irritated.

Stage	What happens
Before	You're positioned, the skin is cleaned and numbed, and live imaging (fluoroscopy or ultrasound) guides the needle
During	The medication is placed precisely at the epidural space in your neck; most people feel pressure more than sharp pain
After	You rest briefly and go home the same day — arrange a driver if you received sedation

What Are the Benefits?

CESIs have been used since 1986 and are considered the main treatment for cervical radiculopathy and chronic neck pain. Most importantly, CESIs are minimally invasive, allowing you to return to normal life as soon as possible.

How Often Should This Procedure Be Done?

You can receive up to three injections in a six-month period, with two or three weeks between each. You may find that you experience relief after one or two injections and do not need the standard group of three.

When Will I Feel Better?

Many see results immediately after the second injection, while effects can start within two to three days.

Is a Cervical Epidural Injection Right for Me?

If your chronic neck pain has continued for more than four weeks and has not been helped by other conservative therapies, you may consider this treatment.

Risk Factors

Complications may include bleeding, headache, infection, allergic reaction to medication, and any reaction caused by the medications themselves. Your physician will use fluoroscopy to ensure proper needle placement, reducing risk of complications.

Evidence of Performance

In 1993, a study was published on CESIs' effectiveness in treating neck and arm pain long-term, with 68% of patients reporting positively. A 1994 study found 71% of patients experiencing a 75% pain reduction. In 2007, studies showed that multiple injections are much more effective than single injections.

How it's performed

The patient is positioned and the skin over the neck is cleaned and anesthetized. Under live fluoroscopic (X-ray) guidance, a needle is advanced into the cervical epidural space, most commonly by an interlaminar approach at the C7-T1 level where the space is largest. Contrast dye confirms correct placement and spread and rules out vascular uptake. A corticosteroid and local anesthetic solution is then injected to bathe the inflamed nerve roots.

How to prepare

Arrange a driver for the day of the procedure. Discontinue blood thinners only as directed by the prescribing physician. You may eat lightly unless sedation is planned. Bring recent cervical MRI or CT imaging and a current medication list. Notify the office if you have an active infection, fever, or uncontrolled diabetes.

What to expect after

Ice the injection site 20 minutes every 2 to 3 hours for the first day. Avoid strenuous activity, heavy lifting, and driving for 24 hours. Expect a possible temporary increase in pain for 1 to 2 days before the steroid takes effect. Monitor blood glucose closely if diabetic. Report fever, severe headache, new arm or leg weakness, difficulty breathing, or loss of bladder or bowel control immediately.

Outcome

Most appropriately selected patients experience meaningful reduction in neck and radiating arm pain, with benefit typically lasting weeks to months and often improving with a short series of injections. Relief creates a window to progress with physical therapy.

Frequently asked

Cervical Epidural Injection questions, answered

What is a cervical epidural steroid injection?

It's an anti-inflammatory injection into the epidural space of the neck to calm an irritated nerve. It's used for neck pain or pain radiating down the arm.

What conditions does a cervical epidural treat?

It commonly helps a pinched nerve in the neck from a herniated disc or stenosis, especially when it causes arm pain, numbness, or tingling. It can ease symptoms enough to rehab.

How long does a cervical epidural last?

Relief ranges from weeks to months and varies by person. It's often part of a plan with physical therapy and may be repeated.

Is a cervical epidural injection safe?

Performed with live imaging by an experienced physician, it's generally safe, though the neck requires particular care. Your doctor reviews the small risks with you.

When should I call afterward?

Mild soreness is normal; seek care for fever, severe pain, new arm or leg weakness, or trouble with balance, which are uncommon but need prompt attention.

Sources

References

Barreto MdM, et al. Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis: Systematic Review Summary — Report of the AAN Guidelines Subcommittee. Neurology 2025 — https://pubmed.ncbi.nlm.nih.gov/39938000/
Manchikanti L, Knezevic NN, Knezevic E, et al. Epidural Interventions in the Management of Chronic Spinal Pain: ASIPP Comprehensive Evidence-Based Guidelines. Pain Physician 2021;24(S1):S27–S208 — https://www.painphysicianjournal.com/current/pdf?article=NzIwNg%3D%3D
House LM, Barrette K, Mattie R, McCormick ZL. Cervical Epidural Steroid Injection: Techniques and Evidence. Phys Med Rehabil Clin N Am 2018;29(1):1–17 — https://pubmed.ncbi.nlm.nih.gov/29173657/
Patel K, Chopra P, Upadhyayula S. Epidural Steroid Injections. StatPearls. NCBI Bookshelf — https://www.ncbi.nlm.nih.gov/books/NBK470189/
North American Spine Society. Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disorders — https://www.spine.org/Research-Clinical-Care/Quality-Improvement/Clinical-Guidelines
National Institute of Neurological Disorders and Stroke: Neck Pain — https://www.ninds.nih.gov/health-information/disorders/neck-pain

SpecialtyPain ManagementTypeProcedureBody locationCervical spine, cervical epidural space, C5-C6, C6-C7, cervical nerve rootsCPT code62320 (interlaminar, without imaging), 62321 (interlaminar, with imaging); 64479 (transforaminal, first level), 64480 (transforaminal, add-on)

This page is for general education and is not a substitute for medical advice. Whether a given procedure is appropriate depends on your individual evaluation. Contact a Remix Medical clinician to discuss your care.

Updated January 19, 2024. Medically reviewed by Raju Mantena, DO.