Cervical Epidural (Trans-facet) Injection

A cervical epidural (trans-facet) injection involves injecting local anesthetic and a steroid into a facet joint in the neck. The joint capsule is completely filled in order to push the medication out of the joint and into the adjacent pinched nerve. Cervical epidurals can be used as a treatment to relieve neck pain and referred symptoms into the arm.

These injections typically relieve pain for 3-6 months. If successful, repeat injections can be performed.

HOW DO I PREPARE FOR MY PROCEDURE?

• You must have had an MRI or CT within the past 24 months.
• If you’ve had recent surgery, but not updated your images, please inform the booking coordinator prior to injection.
• It’s recommended that you do not wear jewelry around your neck or in your ears to your appointment. If you have long hair, please bring a hair tie to your appointment to keep your hair secured during the injection.
• If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin, etc.) you will need to have an international normalized ratio (INR) test and temporarily stop your medication prior to the procedure. Please inform our booking coordinators so that they can discuss this in more detail with you.
• You must have a driver accompany you to this appointment.
• If you have diabetes, please eat one hour before your appointment.
• Please arrive 15 minutes before your appointment to allow enough time to check in with reception and fill out a consent form.
• Bring photo identification and your provincial health card.
• Take all prescribed medications as directed.
• Wear comfortable clothes.
• Please do not bring children who require supervision.

WHAT HAPPENS DURING MY PROCEDURE?

• We can provide you with a comfortable clinic gown to change into (depending on the area being treated).
• A team member will review the consent form and procedure details, and answer any questions.
• We will then escort you to our treatment suite where you will lie on your stomach with your neck flexed and your forehead resting on the table. This opens the facet joints for easier access with the needle.
• The radiologist will clean the skin and inject a local anesthetic, similar to the freezing you would get at the dentist.
• After the location is confirmed with X-ray guidance, the steroid and freezing will be injected into the joint using a thin needle.
• It is possible you will feel pain or pressure similar to your normal symptoms as the medicine is being injected. This can be an encouraging sign of the medicine going into the symptomatic place, and the pain usually disappears quickly.
• A Band-Aid will be placed at the injection site, then you will be transferred to a wheelchair and brought into another room.
• After 15 minutes, you will be checked for the expected injection response. If you are able to stand and walk safely, you will be free to leave with your driver.

POST-PROCEDURE INSTRUCTIONS

• First 24 hours:
  • Keep the treatment area clean. Leave the Band-Aid on. Do not shower.
  • Avoid driving.
  • If possible, please avoid nonsteroidal, anti-inflammatory medication for 24 hours (i.e., ibuprofen/Advil).
  • A feeling of heaviness, numbness, and tingling in one or both arms is normal and could last for 4-6 hours.
• First 48 hours:
  • Avoid bathtubs, hot tubs, and pools.
  • Avoid strenuous activities and lifting for 3-5 days.
• After one week: You may resume strenuous activity, lifting, and physiotherapy. Be mindful of your pain and stop if it hurts too much. Notify your physiotherapist that you have had this injection so they can modify your exercises if necessary.
• Watch for infection: If you develop worsening pain, skin redness, or pus at the site of injection, or a temperature greater than 38.5°C, please proceed to an urgent care or emergency centre.
• Watch for symptoms of bleeding around the spine: If you have intense neck/shoulder pain that comes quickly and travels down one or both arms and continues to intensify, please call 911 or go to an emergency room right away.
• If you have pain or other symptoms beyond 48 hours after your injection, please call our office at 403-568-3890 or email us at paintherapy@radiology.ca during business hours. You may apply heat and ice to the treatment area.
• Diabetics: Note that cortisone can cause a temporary increase in blood sugar. Please monitor your blood sugar closely and if you have any concerns, consult with your doctor.
• Anti-coagulant therapy: You will be directed when to resume any anti-coagulant (blood thinners) medication.

WHEN WILL I SEE RESULTS?

• After your injection, the freezing will usually last for a few hours. Your symptoms may transiently return thereafter until the steroid takes effect over two weeks. Please track your symptom response to share with your physician.
• These injections typically provide at least three months of symptom relief. If an injection does not help relieve your symptoms, then you may need further evaluation by your referring doctor for another cause of your symptoms.

HOW MUCH WILL IT COST?

This exam is covered under your Alberta Health Care Plan. It is not currently offered at our Saskatchewan clinics.