Cervical Epidural Steroid Injection

Medically reviewed by Joshua L. Hare, DO, Founder & Medical Director

Conditions Treated

Cervical radiculopathy, herniated cervical discs, cervical spinal stenosis, cervical spondylosis

Cervical Epidural Steroid Injection at a Glance

Purpose	Therapeutic — an anti-inflammatory dose delivered directly to the space around a compressed cervical nerve root
Guidance	Fluoroscopy, with contrast injected to verify proper epidural spread[1] before any medication is delivered
Usual entry level	C7-T1, at the base of the neck — the ligamentum flavum is consistently present at that level, reducing the risk of complications[1]
What is injected	A corticosteroid combined with preservative-free saline and possibly a local anesthetic[1]
Sedation	Minimal or none — patient communication and cooperation are critical for a safe outcome[1]
Time in the room	Up to 30 minutes, depending on your anatomy[1]
Treatment plan	An initial injection followed by 1 or 2 additional injections spaced 2 to 4 weeks apart,[1] if needed
Ride home	A driver is required

Why the Needle Starts at the Base of the Neck

Even when the pinched nerve sits higher in the neck, the injection is usually placed where the cervical spine meets the thoracic spine. The reason is a safety margin you can see on anatomy alone: the posterior epidural space is limited above the C7-T1 level,[1] and at C7-T1 the ligament the needle rests against before entering the space is reliably present. From there the medication spreads upward through the epidural space to bathe the inflamed levels above.

Placement is never done by feel alone. The physician advances the needle using a loss-of-resistance technique that signals when the tip has passed through the ligamentum flavum into the epidural space,[1] confirms the position with contrast dye on the fluoroscope, and aspirates to check for cerebrospinal fluid or blood[1] before the steroid goes in.

What the Steroid Is Doing in There

A compressed nerve root is also an inflamed one, and the inflammation is measurable. Imaging research has found significantly elevated markers of inflammation at the neuroforamina, which supports the use of corticosteroids as a targeted therapeutic approach.[1] By reducing swelling and inflammation at the site of nerve compression, the injection relieves not only neck pain but also the shoulder and arm pain[1] that cervical radiculopathy sends down the limb. If the mixture includes a local anesthetic, its effect can be felt the same day; the steroid’s anti-inflammatory effect builds over the days that follow.

Who This Injection Is For

Cervical radiculopathy is common — it affects roughly 107 per 100,000 men and 63 per 100,000 women each year, with peak incidence between ages 40 and 60.[1] An epidural injection is considered when conservative treatments such as rest, anti-inflammatory medication, physical therapy, and cervical collars fail to provide adequate relief after 6 to 8 weeks,[1] and the neurological exam remains stable. The evidence base is strongest exactly where most of our patients sit: there is robust evidence supporting cervical epidural injections for pain resulting from cervical disc herniation, central spinal stenosis, and post-surgical syndrome.[1]

Before any injection, we confirm the target. MRI or CT imaging is essential to verify stable nerve root compression[1] from degenerative changes or a herniated disc — and it helps avoid injecting at critically stenotic levels, where the risk of complications is elevated.[1] If you already have imaging, bring it.

The Injection, Step by Step

1. You lie face down with your head supported in a flexed position that helps widen the spaces between the laminae.[1]
2. The skin is cleaned with antiseptic and numbed with local anesthetic.
3. Under fluoroscopic guidance, the epidural needle is advanced toward the C7-T1 interlaminar space.
4. A loss of resistance signals that the needle has entered the epidural space.
5. Contrast dye confirms the spread pattern on the screen; the physician aspirates as a final check.
6. The corticosteroid mixture is injected while the physician talks with you and monitors for any new symptoms.
7. After a short observation period, your driver takes you home.

What the Evidence Shows

For patients whose radicular pain has already resisted weeks of conservative care, epidural injections can offer substantial relief in refractory cases, with about 50% of patients achieving a 50% reduction in pain lasting 3 months.[1] The benefit can also be compounded: subsequent injections within a year may add to the relief of the one before.[1] Performed well, on the right patient, these injections can reduce pain, improve function, and delay or eliminate the need for surgery.[1]

Risks and Side Effects

Serious complications from epidural corticosteroid injections are uncommon,[1] and the procedure’s safeguards — the C7-T1 entry level, contrast confirmation, aspiration, and staying awake enough to talk — each exist to keep them that way. The side effects patients actually encounter are mostly minor and short-lived: neck pain (6.7%), headache (1.7%), insomnia (1.7%), and vasovagal reactions (1.5%)[1] were the most frequently reported, with headaches reported in 4.5% of patients receiving interlaminar injections[1] and a temporary increase in radicular pain noted in up to 18% of cases,[1] which settles on its own. The incidence of dural puncture with the interlaminar approach is between 0.25% and 2.0%.[1] Rare but serious events — epidural hematoma, infection, nerve injury — have been reported, which is why this procedure belongs in experienced hands with full imaging; notably, no severe complications have been reported with the corticosteroid dexamethasone.[1] Temporary arm numbness after the injection is possible, and a driver is required.

Common Questions

My pain is at C5. Why inject at C7-T1?

The epidural space is a connected column, and medication injected at the base of the neck spreads upward to the inflamed levels. Entering at C7-T1 is the standard because the ligament that guides needle placement is reliably present there, which makes the entry both more predictable and safer than puncturing higher up.

Why will I be awake for this?

Because talking with you is part of the monitoring. It lets the physician catch any new sensation the moment it appears, and intravenous sedation carries a higher rate of complications than local anesthesia alone[1] for this procedure.

How many injections can I have?

A typical plan is an initial injection followed by one or two more, spaced 2 to 4 weeks apart, judged on your response. Repeat injections within the year can build on the relief of the first.

Do I really need an MRI first?

Yes. Imaging confirms that a compressed nerve root is actually the cause of your symptoms, and it lets the physician steer clear of levels where the canal is critically narrow.

References

Clinical sources for this page.

1. Cervical Epidural Injection. StatPearls [Internet], National Library of Medicine; updated June 2, 2025. Back to first citation ↑