Therapeutic neck injections manage pain originating from spinal structures or surrounding muscles in the cervical region. These procedures involve delivering medication, such as corticosteroids and local anesthetics, directly into or near the affected nerves, joints, or soft tissues of the neck. The primary goal is to interrupt pain signals and reduce localized inflammation that may be causing discomfort that radiates into the head, shoulders, or arms. Understanding the safety profile requires distinguishing between the different types of injections and their respective anatomical targets.
Categorizing Types of Therapeutic Neck Injections
The term “neck injection” encompasses several procedures designed to treat specific sources of pain within the cervical spine. The most common type is the Cervical Epidural Steroid Injection (CESI), which targets the epidural space surrounding the spinal cord and its exiting nerve roots. CESIs are primarily used to treat cervical radiculopathy, or “pinched nerve” pain, caused by a herniated disc or spinal stenosis.
Within CESI, two main approaches exist: the interlaminar and the transforaminal technique, differing in how the needle reaches the epidural space. The interlaminar approach places the needle between the bony laminae at the back of the spine to deliver medication into the epidural space. The transforaminal approach targets the medication more precisely toward the nerve root as it exits the spine through the neural foramen. This approach is generally considered higher-risk due to the proximity of major blood vessels.
Another category includes Cervical Facet Joint Injections and Medial Branch Blocks, which address pain originating from the small, paired joints located at the back of the vertebrae. Facet joints can become painful due to arthritis or mechanical stress. A facet joint injection places medication directly into the joint capsule. A medial branch block targets the small nerves (medial branches) that transmit pain signals from the facet joint to the brain.
Trigger Point Injections (TPIs) do not involve the spine but target the surrounding muscles. These injections target myofascial trigger points, which are palpable, painful knots that form in muscle tissue, such as the trapezius or levator scapulae muscles. A TPI typically involves injecting a local anesthetic, sometimes with a corticosteroid, directly into the muscle knot to release contracted fibers and alleviate pain.
Immediate and Common Safety Concerns
Most patients experience only minor, temporary side effects that resolve quickly after a neck injection. The most frequent discomfort is localized pain, soreness, or bruising at the needle insertion site, which is an expected reaction. This temporary increase in pain often occurs as the local anesthetic wears off and before the anti-inflammatory medication takes effect, usually lasting a few days.
Some individuals may experience a transient headache, which can indicate a small leak of spinal fluid (post-dural puncture headache), though this is uncommon. Steroids can cause temporary side effects such as facial flushing (a warm, red sensation on the face or chest) or a mild, short-lived fever. Other short-term reactions include temporary lightheadedness, nausea, or dizziness, often related to a vasovagal response or the anesthetic used.
Severe Complications and Risk Mitigation
Neck injections are generally low-risk procedures, but they carry a small chance of severe complications that warrant careful attention. The most devastating, though extremely rare, risk is associated with the unintended injection of medication into a blood vessel, particularly during the transforaminal approach of a CESI. An intravascular injection, especially with certain particulate steroids, can block small arteries supplying the spinal cord or brainstem, potentially causing a stroke, paralysis, or spinal cord infarction.
Infection is another serious risk, including localized abscesses or, less frequently, meningitis, which necessitates strict sterile techniques during the procedure. Bleeding complications, resulting in a hematoma that compresses the spinal cord or nerve roots, are a concern, especially for patients taking blood-thinning medications. Direct nerve or spinal cord injury, while rare, can occur from aberrant needle placement, potentially leading to long-term neurological deficits or chronic pain.
To mitigate these dangers, physicians use several safety measures. Real-time X-ray guidance, called fluoroscopy, is used to visualize the needle’s path to its target. The injection of contrast dye before the medication is administered is a standard technique to confirm the needle tip is not inside a blood vessel or the spinal canal. Additionally, the use of non-particulate, soluble steroids for transforaminal injections is often preferred, as they are less likely to cause an arterial blockage if they enter the bloodstream.
When Injections Are Not Recommended
Certain patient conditions or circumstances make therapeutic neck injections unsafe, acting as contraindications. An absolute contraindication is an active systemic infection or a localized skin infection at the planned injection site. The needle could carry bacteria into the deep tissues of the spine, leading to an abscess or meningitis. Patients with uncontrolled bleeding disorders or those who cannot safely stop taking blood-thinning medication are typically excluded due to the elevated risk of a spinal hematoma.
Known allergies to any component of the injection, such as the local anesthetic, corticosteroid, or the contrast dye, would prevent the procedure. Pregnancy is generally considered a relative contraindication because the procedure relies on fluoroscopy, which uses radiation that could pose a risk to the fetus.
Patients who exhibit signs of unstable neurological deficits, such as rapidly worsening muscle weakness or loss of bowel or bladder control, usually require immediate surgical evaluation rather than an injection.