Trans-Facet Cervical Epidural

A cervical epidural (trans-facet) injection involves injecting local anesthetic and a steroid into a facet joint in the neck. The joint capsule is completely filled in order to push the medication out of the joint and into the adjacent pinched nerve. Cervical epidurals can be used as treatment to relieve neck pain and referred symptoms into the arm.

Relief may occur within two weeks and can last 3-6 months, or longer. Often MRI is requested prior to this treatment to confirm the diagnosis, select the best injection site, and avoid complications.

HOW DO I PREPARE FOR MY PROCEDURE?

• You must have an ultrasound of the area of concern prior to your injection to ensure the procedure is safe to perform.
• If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin, etc.) you may need to have an international normalized ratio (INR) test and temporarily stop your medication prior to the procedure. Please inform our booking coordinators so that they can discuss this in more detail with you.
• If you have diabetes, please eat one hour before your appointment.
• IMPORTANT: Please schedule your injection either two weeks before or one week after any vaccination appointment.
• If you are currently taking antibiotics, you will need to wait two days after your last dose before having your injection.
• Take all prescribed medications as directed.
• Arrive 15 minutes prior to your appointment.
• Wear comfortable clothing.
• Bring photo identification and your provincial health card.
• Please do not bring children who require supervision.

WHAT HAPPENS DURING MY PROCEDURE?

• A team member will review the consent form and procedure details, and answer any questions.
• We will then escort you to our treatment suite where you will meet the radiologist who will clean the skin and inject a local anesthetic, similar to the freezing you get at the dentist.
• The needle is then positioned under X-ray guidance and the correct location on the body is confirmed with X-ray dye.
• For a trans-facet cervical epidural, you will be asked to lie on your stomach with your neck flexed and your forehead resting on the table. This opens the facet joints for easier access with the needle.
• It is possible you will feel pain or pressure as the medicine is injected. This is a good sign and means the medicine is going to the right place. The pain usually disappears quickly.
• A Band-Aid will be placed at the injection site, then you will be transferred to a wheelchair and brought into another room.
• After 15 minutes, you will be checked for the expected injection response. If you are able to stand and walk safely, you will be free to leave with your driver.

POST-PROCEDURE INSTRUCTIONS

• First 24 hours: Keep the treatment area clean. Leave the Band-Aid on. Do not shower. Avoid driving.
• If possible, please avoid anti-inflammatory medication for 24 hours (i.e., ibuprofen/Advil). A feeling of heaviness, numbness, or tingling in your arm is normal and could last for 4-6 hours.
• First 48 hours: Avoid bathtubs, hot tubs, and pools. Avoid strenuous activities and lifting.
• After one week: You may resume strenuous activity, lifting, and physiotherapy. Be mindful of your pain and stop if it hurts too much. Notify your physiotherapist that you have had this injection so they can modify your exercises if necessary.
• Watch for infection: If you develop worsening pain, skin redness at the site of injection, or a temperature greater than 38.5°C, please proceed to an urgent care or emergency centre.
• Watch for symptoms of bleeding around the spine: If you have intense neck pain that comes quickly and travels down one or both arms and continues to intensify, please call 911 or go to an emergency room right away.
• If you have increased pain or other symptoms beyond 48 hours after your injection, please call our office at 403-568-3890 or email us at paintherapy@radiology.ca during business hours. You may apply heat and ice to the treatment area.
• Diabetics: Note that cortisone can cause a temporary increase in blood sugar. Please monitor your blood sugar closely and if you have any concerns, consult with your doctor.
• Anti-coagulant therapy: You will be directed when to resume any anti-coagulant (blood thinners) medication.

WHEN WILL I SEE RESULTS?

• After your injection, the freezing may last for a few hours. Your symptoms may return until the steroid takes effect in two weeks. Please track your symptom response to share with your physician.
• These injections typically provide at least three months of symptom relief. If an injection does not help relieve your symptoms, then you may need further evaluation by your referring doctor for another cause of your symptoms.

HOW MUCH WILL IT COST?

This procedure is covered under your Alberta Health Care Plan. It is not currently offered at our Saskatchewan clinics. If you have the procedure with PRP, there will be an added cost.