Fluoroscopy-guided spine injection
Cervical Epidural Steroid Injection
If you have shooting pain, numbness, or tingling running down an arm — or that deep neck pain that won't let you turn your head — this is one of the most useful tools I have. Here's exactly what I'll do, why, and what to expect.
What I'm doing
Calming an angry nerve in your neck
When a nerve in your neck is pinched or irritated — by a herniated disc, bone spur, or a narrowed canal — it swells. That swelling is what makes the pain shoot down your arm or into your shoulder blade.
I deliver a small dose of anti-inflammatory medication — a steroid mixed with a local numbing medication — into the cervical epidural space. That's the cushion of fat and tissue right outside the sac that holds your spinal cord and nerves. The medicine bathes the irritated nerve and quiets the inflammation. The nerve gets a chance to heal. You get a chance to move again.
I want to be especially honest about the cervical level: your spinal cord and the vertebral arteries are right there, and that's why this procedure deserves more care than a lumbar injection. I do every cervical epidural under live X-ray with contrast confirmation — I will not advance the needle without seeing exactly where I am. The two approaches I use, depending on your case, are the interlaminar approach (medication spreads broadly across the back of the cervical spine) and the transforaminalapproach (medication is directed at a specific nerve root through the opening where it exits the spine). I'll explain my reasoning before we start.
Honest expectations
What this can do — and what it can't
Most patients get real relief. The cervical level needs special care, but in trained hands the procedure is safe and effective.
What this can do for you
- Cuts the inflammation around the irritated nerve in your neck, often dropping arm pain enough that you can sleep, work, and start physical therapy.
- Targets the actual source of your pain — not a body-wide painkiller.
- Minimally invasive — needle only, no incision, same-day discharge.
- Can help you avoid or delay neck surgery.
- Decades of safety data when done with image guidance.
Risks I'll be honest about
Most are uncommon, and I take specific precautions at the cervical level.
- Soreness in the neck for a day or two(common)
- Brief bump in blood sugar — important for diabetics(common in diabetics)
- Brief facial flushing or fluid retention from the steroid(occasional)
- Headache that gets worse when sitting up (post-dural-puncture headache)(uncommon, treatable)
- Temporary numbness or weakness in an arm from the local anesthetic(occasional, hours)
- Infection at the injection site(rare with sterile technique)
- Vascular injury or spinal cord injury — the reason I use live X-ray(very rare)
A word on the steroid itself
I usually limit you to no more than 3 cervical epidural injections in the same area per year. If you're needing them more often than that, we should be talking about a different plan — radiofrequency ablation if the facet joints are involved, or a surgical consultation if the structural problem is the driver.
Other options
Things we could try instead, or alongside
An injection isn't the only path. Depending on your case, any of these may make more sense as the next move.
Physical therapy
Targeted strengthening of the deep cervical stabilizers, postural retraining, and mobility work. Often the most under-used tool.
Where this fits: Almost everyone benefits — usually as the foundation an injection just gets you back to.
Anti-inflammatory medications
Oral NSAIDs (ibuprofen, naproxen, meloxicam) or short oral steroid tapers can calm cervical inflammation without a needle.
Where this fits: First-line for acute flares, when your kidneys and stomach can tolerate them.
Nerve pain medications
Gabapentin or duloxetine can quiet electric, burning arm pain.
Where this fits: When the pain is more nerve-type than mechanical.
Cervical facet RFA
If the pain ends up being from your facet joints (axial neck pain rather than arm pain), RFA gives 6–18 months of relief.
Where this fits: When diagnostic blocks confirm the facets are the source.
Surgical consultation
If your imaging shows severe stenosis, instability, or progressive weakness, surgery may be the right answer.
Where this fits: When conservative care has failed, when there's neurological loss, or when imaging clearly explains your symptoms.
Before your visit
How to get ready
A few important things — please read all of them.
One thing I want you to know first
You will not be put to sleep for this.A lot of patients walk in expecting general anesthesia — that's not what happens here. If we're using conscious sedation (only at the surgery center, only in select cases), you'll get a relaxant through an IV that takes the edge off. You'll still be awake. You'll still be able to talk to me. You just won't be anxious. Most patients say it felt easier than they imagined.
Bring a driver
Eating and drinking before
Take your morning medications
Blood thinners — talk to me first
- • Aspirin (81 mg) — usually OK to continue. I'll tell you if I want it held.
- • Plavix (clopidogrel) — typically held 5–7 days before
- • Eliquis (apixaban) — typically held 24–48 hours before
- • Xarelto (rivaroxaban) — typically held 24–48 hours before
- • Pradaxa (dabigatran) — typically held 24–72 hours, depending on kidney function
- • Warfarin (Coumadin) — typically held until INR is below 1.5
- • Lovenox (enoxaparin) — typically held 12–24 hours
Tell me about your allergies
What to wear
The day of
Step by step, what actually happens
The whole appointment is usually 1.5–2 hours. The injection itself is much shorter.
- 1
Arrival and check-in
You'll come in with your driver, finish paperwork, change into a gown, and a nurse will start an IV.
- 2
I see you before we start
I'll go over the plan again, answer any last questions, and confirm consent. Last chance to mention allergies or anything weighing on you.
- 3
Into the procedure room
You'll lie face down on the procedure table with your forehead supported. The C-arm X-ray sits over you, with a monitor beside it.
- 4
Numbing the skin
I'll inject local numbing medication into the skin and deeper tissue. Brief sting for a few seconds, then it goes numb.
- 5
The injection itself
Using live X-ray, I guide a thin needle to the right spot, inject contrast dye to confirm placement, then deliver the steroid and anesthetic. Total time: usually 10–20 minutes.
- 6
Recovery
About 30 minutes in recovery — vitals, snack, making sure your arms work normally before you stand up. Then your driver takes you home.
After
Recovery, activity, and what to watch for
First 24 hours
Take it easy. Ice the neck if it's sore. The numbing may give you a few hours of immediate relief — that's the local anesthetic, not the steroid yet. An arm may feel temporarily heavy or weak; that fades.
Days 1–3
Mild soreness is normal. Your usual pain may briefly come back or feel slightly worse before the steroid kicks in. Don't panic. This is expected.
Days 3–7
The steroid starts working. Most patients notice meaningful improvement during this window. Resume light activity as you feel ready.
Weeks 2–6
Peak benefit. This is when most patients feel best. Use this window for the rehab work that produces the durable result.
When to call me right away
Severe new weakness in your arms or legs
If a limb feels significantly weaker than before — trouble lifting it, dragging a foot, dropping things — that needs attention now.
Loss of bladder or bowel control
Sudden trouble holding it or sudden trouble going. Rare, but a true emergency. Go to the ER, then call me.
Fever above 101°F (38.3°C)
A fever in the days after the procedure, especially with chills, can mean infection.
Spreading redness, warmth, or drainage at the injection site
Some bruising and tenderness is normal. Pus, increasing redness expanding outward, or yellow drainage is not.
Severe new pain that's worse than before
Brief soreness for a few days is expected. Sharp, severe new pain different from your usual is not.
Severe headache that gets worse when you sit or stand up
If a headache comes on a day or two after and is markedly worse upright than lying flat, that may be a post-dural-puncture headache. Treatable. Call me — don't tough it out.
Difficulty breathing or speaking, severe new arm/leg weakness
Cervical-specific red flag. Rare, but a true emergency. Go to the ER, then call me.
For anything that worries you, call my office. I'd much rather hear from you and tell you it's fine than have you wait at home wondering. For loss of bladder/bowel control or anything that feels like a true emergency, go to the nearest ER — then call me.
The questions I get most
Frequently asked
Will I be put to sleep?
Is a cervical injection riskier than a lumbar one?
How fast will I feel better?
How long does the relief last?
Can I drive myself home?
Will it hurt?
What if it doesn't work?
Have Questions?
If you'd like to learn more about your treatment options or have a question for Dr. Patibanda, reach out.
Contact Dr. Patibanda