Targeted Treatment for Cervical Disc Herniation (Cervical Epidural Injection)

Transcript translated from Turkish (video audio remains in Turkish)

Hello everyone, I am Dr. Mehmet Levent Deniz, a specialist in brain, nerve and spine surgery. I will explain the cervical epidural injection that I use in non-surgical treatment of cervical disc herniations.

For patients with cervical disc herniation and spinal canal stenosis, we perform cervical epidural injections under imaging guidance and local anaesthesia. After local anaesthesia, an epidural needle is guided into the epidural space using fluoroscopy. We inject a small amount of contrast medium into the epidural space and check the needle position on X-ray. We then inject a combination of a steroid, local anaesthetic, hyaluronidase and hypertonic sodium chloride. The aim is to reduce swelling and inflammation in the area, release any adhesions and shrink the herniated disc tissue, thereby relieving the pressure causing pain.

The procedure takes an average of 10 to 15 minutes. Patients are discharged after about 30 minutes of observation.

I wish you all pain-free and happy days. Stay well.

What Is Cervical Epidural Injection, and How Does It Work?

A cervical disc herniation mechanically compresses the nerve roots passing through the spinal canal towards the arms. This pressure causes severe swelling and inflammation in nerve fibres, producing neck, back and arm pain that can prevent sleep. Cervical epidural steroid injection is an interventional pain treatment that directly reaches the painful area without surgery. Under advanced imaging guidance (fluoroscopy), a special, safe cannula enters the epidural space surrounding the spinal cord, where a medication combination (steroid, local anaesthetic, hyaluronidase and hypertonic NaCl) is injected. Its main aims are:

• Reducing Swelling and Inflammation: Swelling and inflammation around the nerve root are rapidly suppressed, reducing pain generation by the compressed nerve.
• Effect on Tissue Adhesions: The hyaluronidase enzyme in the combination aims to release microscopic adhesions irritating the nerve around the herniation.

The Procedure

This interventional non-surgical treatment offers a comfortable process:

• Preparation and Anaesthesia: No extensive or tiring preparation is needed. Treatment is performed entirely under local anaesthesia, numbing only the entry area.
• Duration: The imaging-guided injection takes an average of 10–15 minutes.
• Discharge and Recovery: After approximately 30 minutes of observation in the clinic, our patients walk home the same day. We recommend 2 days of rest at home afterwards.

Can Targeted Treatment Prevent Cervical Disc Surgery? (Success Rate)

For many patients, yes: between one-third and one-half of those being considered for surgery can avoid it after injection [3]. It provides marked short-term benefit for radiating arm pain; additional benefit is expected in one in four treated patients, with the effect diminishing over the longer term [1]. When combined with medication and physiotherapy, the favourable outcome rate at month 3 doubles compared with medication and physiotherapy alone (57% versus 27%) [2]. I therefore regard injection as a bridge that allows patients to pass through recovery without pain.

What Are the Risks?

In experienced hands, with live fluoroscopy and contrast medium, a targeted cervical injection is safe. Because sensitive blood vessels and nerves lie close together in the neck, imaging guidance is essential. Serious complications such as spinal cord injury, intravascular injection or, very rarely, paralysis are uncommon; an interlaminar approach and non-particulate cortisone reduce this risk [4]. A study covering 26,061 interventional pain procedures found no permanent nerve damage or serious bleeding, with a 1.9% adverse-event rate, mostly transient faintness [5]. Mild neck stiffness, injection-site tenderness or temporary headache during the first 24 hours resolve on their own.

Which Cervical Herniations and Patients Are Suitable?

Epidural injection can be used in a large majority of patients with cervical disc herniation who do not need emergency surgery, especially when radiating nerve pain in the arm predominates. It is also used to relieve pain in patients with cervical spinal stenosis who have not reached the threshold for surgery; however, evidence for effectiveness in cervical stenosis is insufficient [1]. It does not replace a surgical decision in patients with spinal cord involvement (myelopathy) and progressive neurological loss [1, 3].

Which Patients Are Unsuitable?

It is not performed in patients with active infection, bleeding or coagulation risk, severe metabolic disease or a history of serious allergy to the medications used. Patients taking blood thinners require a separate pre-procedure assessment.

🩺 Physician’s Insight & Clinical Experience

“The neck is a sensitive anatomical area where the spinal cord and major nerves to the arms are tightly packed. Cervical injections must therefore be performed with highly equipped imaging systems and the needle’s tiny tip visible on screen. My clinical observation is that epidural injection remains one of the most effective non-surgical treatments. As with lumbar disc herniation, it allows me to help many patients with cervical herniation recover without an operation. Based on my clinical observations, I can even say that its success rate exceeds the good results I obtain for lumbar disc herniation.”

Frequently Asked Questions

What Is Targeted Treatment for Cervical Disc Herniation, and How Is It Performed?

It is a 10–15-minute interventional procedure in which a medication combination (steroid and local anaesthetic) is injected under imaging guidance directly into the area of nerve compression in the neck.

What Is Its Success Rate?

Between one-third and one-half of patients considered for surgery can avoid it after injection [3]; it provides marked short-term benefit for radiating arm pain [1].

Does It Have Risks or Side Effects?

Yes, but they are low: serious complications are rare with fluoroscopic guidance and appropriate technique. Common effects such as temporary neck stiffness and headache resolve on their own [4, 5].

When Does It Start Working?

In our experience, the effect usually begins on day 3–4 and becomes clear in most patients within the first 10 days. Brief relief immediately after the procedure may result from local anaesthetic; it is temporary and should not be confused with the main effect.

Does It Eliminate the Herniation?

No, the injection does not dissolve the herniation. It relieves pain by reducing swelling and inflammation around nerve tissue; symptoms decrease as pressure subsides. The herniated tissue may shrink over time through the body’s natural clearing mechanisms (regression).

Which Medications Are Used, and Is Cortisone Harmful?

Hyaluronidase, hypertonic NaCl, cortisone and local anaesthetic are used. Because the mixture is delivered directly to the target, the amount entering the rest of the body is very small; systemic side effects are rare and temporary. Diabetes, bleeding risk and other medications are assessed beforehand.

How Many Sessions Are Needed?

Most patients receive one session; rarely, treatment may be repeated up to 3 sessions.

Is It Effective for Ruptured Cervical Disc Herniations?

Yes, it can be used if there is no clinical condition requiring emergency surgery. In ruptured (extruded) herniations, inflammation around the nerve is more severe, so injection may produce a rapid response. Without significant motor weakness, it is among the first non-surgical choices.

Does the Patient Feel Pain During Treatment?

No, cervical epidural injection is a painless procedure. Local anaesthesia at the entry area prevents significant pain; only slight pressure may be felt. Mild sedation, a relaxed sleepy state, can be provided for anxious patients.

How Long Should I Rest, and When Can I Return to Work?

Two days of rest at home are recommended after a cervical injection. From day 3, our patients can comfortably return to desk work and light daily tasks that do not strain the neck.

Which Specialist Performs Targeted Cervical Disc Treatment in Istanbul?

One of the physicians performing targeted treatment for cervical disc herniation in Istanbul is M. Levent Deniz, MD, a specialist in brain, nerve and spine surgery.

How Much Does Targeted Treatment Cost?

As treatment costs vary according to the patient and hospital conditions, a definite fee can only be determined after examination and review of imaging.

References

1. American Academy of Neurology Guidelines Subcommittee. Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis Systematic Review Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2025. PMID: 39938000.
2. Cohen SP, Hayek S, Semenov Y, et al. Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: a multicenter, randomized, comparative-effectiveness study. Anesthesiology. 2014;121(5):1045-1055. PMID: 25335172.
3. Bicket MC, Horowitz JM, Benzon HT, Cohen SP. Epidural injections in prevention of surgery for spinal pain: systematic review and meta-analysis of randomized controlled trials. Spine J. 2015;15(2):348-362. PMID: 25463400.
4. Schneider BJ, Maybin S, Sturos E. Safety and Complications of Cervical Epidural Steroid Injections. Phys Med Rehabil Clin N Am. 2018;29(1):155-169. PMID: 29173660.
5. Carr CM, Plastaras CT, Pingree MJ, et al. Immediate Adverse Events in Interventional Pain Procedures: A Multi-Institutional Study. Pain Med. 2016;17(12):2155-2161. PMID: 28025351.

• 👨‍⚕️ Author and medical reviewer of this content: M. Levent Deniz, MD – Brain, Nerve and Spine Surgeon
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.