Balancing relief and risk: Understanding cervical epidural steroid injections for neck pain
Cervical radiculopathy is a condition where a nerve in the neck gets pinched or irritated, often causing pain that travels from the neck down into the shoulder or arm. This kind of pain can make it hard to move, work or sleep. When basic treatments like physical therapy, rest or medication don’t help, doctors may suggest a procedure called a cervical transforaminal epidural steroid injection (CTFESI). This is a type of shot given near the nerve to help reduce swelling and pain. It is done without surgery and can help some people feel better to get back to their daily activities.
In our recent publication, Risks and Benefits of Cervical Transforaminal Epidural Steroid Injections: A Comprehensive Review, we conducted a comprehensive review of the risks and benefits associated with CTFESIs. Our analysis revealed that while many patients experience significant pain relief and improvement with everyday activities, the procedure is not without risks. Complications, though rare, can be severe, including neurological injuries, infections and serious complications that can occur if the needle accidentally hits a nearby blood vessel or nerve in the cervical spine.
Given these potential risks, ethical considerations become paramount. Informed consent is not merely a formality but a critical process ensuring that patients are fully aware of the potential benefits and risks associated with CTFESIs. Clinicians must engage in transparent discussions, providing patients with comprehensive information to make informed decisions about their care.
Patient selection is another ethical and clinical imperative. CTFESIs are most beneficial for patients with acute radicular pain or sudden nerve pain caused by swelling or irritation around the nerve stemming from inflammatory causes, such as disc herniations. Conversely, patients with chronic pain due to narrowed spaces in the spine may not get lasting relief, and the risks may outweigh the potential relief. Therefore, careful assessment of each patient’s condition, history and response to previous treatments is essential to determine the appropriateness of CTFESIs.
From a policy perspective, the establishment of standardized safety protocols is crucial. Employing advanced imaging techniques like real-time X-ray imaging and choosing safer types of medications can lower the chance of serious side effects associated with the procedure. Institutions should develop and adhere to evidence-based guidelines to ensure patient safety and optimize outcomes.
While CTFESIs offer a valuable treatment avenue for certain patients with cervical radiculopathy, their application must be careful and thoughtful. Ethical practice demands thorough patient education, meticulous selection criteria and adherence to safety protocols to balance the promise of pain relief with the imperative of patient safety.
By Dr. Ashlyn Brown, medical resident, H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine
