What is a Cervical Epidural Steroid Injection?

A Cervical ESI is a non-surgical injection used to help reduce pain coming from irritated or inflamed nerves in the neck. The medicine is placed into the epidural space, which is the area around the spinal nerves.

This treatment is commonly recommended when neck pain or arm pain does not improve with other conservative treatments like physical therapy, medications, stretching, or rest.

Why might you need this injection?

Cervical ESIs may help with pain caused by:

  • A herniated disc in the neck
  • Degenerative disc disease
  • Pinched nerves (cervical radiculopathy)
  • Spinal arthritis or bone spurs
  • Post-surgical neck pain
  • Shingles-related nerve pain

The goal is to calm irritated nerves so you can move better and participate more comfortably in physical therapy or your normal daily routines.

How does the injection help?

The steroid medication reduces inflammation, which is one of the main causes of:

  • Neck pain
  • Arm or shoulder pain
  • Numbness or tingling
  • Nerve irritation

By decreasing inflammation, the injection may reduce pain and help promote healing

What to expect during the procedure

  • The injection is done in a sterile procedure room using X-ray guidance (fluoroscopy) to ensure accurate needle placement.
  • You will lie on your stomach
  • The skin is cleaned and numbed with local anesthetic.
  • Most patients do not need sedation, but it may be offered depending on the situation.
  • The procedure typically takes 10-15 minutes.
  • You may feel a brief sensation down the arm

Afterward, you’ll rest in a recovery area until you’re safe to go home.

After the procedure

  • If you had sedation, do not drive or operate heavy machinery for 24 hours.
  • You may resume normal activities as tolerated the same day.
  • You may shower, but no soaking (baths, pools, lakes) for 24 hours.
  • Soreness at the injection site is common for a day or two.
  • The steroid medicine usually takes 7–10 days to start working.
  • The care team may check in with you the next day to see how you’re feeling.

If your procedure includes sedation

Before the injection:

  • No solid food for 8 hours
  • Clear liquids allowed until 2 hours before (water, broth, clear juices, tea, coffee without cream)
  • No gum, mints, candy, or carbonated drinks for 2 hours
  • The care team will review your medications and tell you what to take the morning of your procedure.

Failure to follow these instructions may require rescheduling for safety.

Possible risks and side effects

Cervical ESIs are considered safe and minimally invasive, but all procedures have risks. Rare risks include:

  • Temporary pain at the injection site
  • Headache (especially if a spinal fluid leak occurs)
  • Bleeding or hematoma
  • Infection (skin infection or very rarely an epidural abscess)
  • Allergic reaction to medication
  • Temporary increase in pain
  • Extremely rare nerve injury
  • Very rare stroke or spinal cord injury
  • Inability to complete the procedure due to anatomy
  • Side effects from steroids (mild flushing, trouble sleeping, temporary rise in blood sugar)

If you take blood thinners, you must notify your provider. These include:

  • Aspirin
  • Plavix (Clopidogrel)
  • Xarelto (Rivaroxaban)
  • Eliquis (Apixaban)
  • Coumadin (Warfarin)
  • Lovenox (Enoxaparin)
  • Heparin
  • Brilinta (Ticagrelor)

Your provider may need to safely pause these medications before the injection.

When will I feel relief?

  • Most patients notice improvement in 7–10 days.
  • Pain relief varies: some people feel relief for weeks to months, while others may need repeat injections depending on the condition.
  • If one approach does not help, your provider may recommend a different type of injection.

You will typically follow up 3–4 weeks after the injection to discuss your results.

Insurance requirements

Most insurance companies require:

  • Recent physical therapy or provider directed home exercise program (often at least 6 weeks)
  • Imaging such as X-rays or MRI
  • Documentation of trials of conservative treatments like medications or home exercises

Your provider’s office will help complete these requirements before scheduling the injection.

Summary

A Cervical Epidural Steroid Injection is a safe, non-surgical option to treat neck and arm pain caused by nerve irritation. It works by placing anti-inflammatory medication near the irritated nerves to reduce pain and improve function. Most patients experience relief within a week, and the procedure itself is quick with minimal downtime.