Houston Methodist. Leading Medicine

Neck FAQ

Question:

I am having severe neck pain from a herniated disc pressing on the spinal cord. Since there is no numbness down my arm, the surgeon suggested a steroid injection. But when I went on-line there were cases of brain damage from this treatment. How does that happen and how often does it happen?

Answer:

Pressure on the spinal cord or spinal nerves in the cervical (neck) region can cause painful disabling symptoms. This condition is called cervical radiculopathy. Usually, it's a herniated disc pressing on the nerve tissue that's causing all of the problems. But these same symptoms could also be caused by a bone spur, spinal infection, or tumor. Painful symptoms associated with cervical radiculopathy can be managed with medication and physical therapy. But a loss of motor control of the arm and hand (progressing to paralysis) is a signal that it's time for surgery. For patients with pain but no other neurologic symptoms, epidural steroid injection (ESI) may be helpful and may also eliminate the need for surgery. As the name implies, epidural steroid injection (ESI) is the injection of a numbing agent (like Novocain) and antiinflammatory (steroid). A long, thin needle is used to inject the medication into the space between the spinal cord and the lining around the spinal cord. The effect of the injection is to block pain messages. It also decreases swelling that is putting pressure on the nerve tissue. As with any invasive procedure, there can be complications from the injection itself. And with any local delivery of medication, there can be adverse effects from the medication itself. In the case of epidural spinal injection for cervical radiculopathy, the most common side effect is nerve irritation (which is usually temporary). The use of fluoroscopy (3-D, real-time X-rays) allows the surgeon to place the needle very carefully without coming into contact with nerve tissue. Only a very small number of patients ever develop serious neurologic damage leading to paralysis. Brain injury such as you mentioned can be caused by epidural hematoma or infection. Studies to date suggest the chances of this developing is less than two per cent. The improvements and advances in fluoroscopy and other imaging to guide surgeons has really improved safety considerably. Sang-Hun Lee, MD, et al. Clinical Outcomes of Cervical Radiculopathy Following Epidural Steroid Injection. In Spine Journal. May 20, 2012. Vol. 37. No. 12. Pp. 1041-1047.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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