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Cervical epidural steroid injection.:

Cervical epidural injections are a useful adjunct in the rehabilitation in patients whose neck pain radiates into the shoulder/arm. They work by placing an anti-inflammatory steroid medication close to an inflamed nerve, thereby allowing the patient to regain full motion and increase the muscular support of the spine.  This reconditioning of the muscles and improved flexibilty aids recovery and reduces the likelihood of future episodes. Most patients require 1-2 injections to receive the full benefit.

Common Indications

• Acute disc herniation/prolapse with or without radiculopathy
• Cervical spondylosis with radiculopathy.

Cervical Radiofrequency denervation:

This is a very successful treatment used in the treatment of neck pain associated with spinal arthritis. It involves cauterising the nerve that sense pain in the neck with a special needle.  Commonly performed as a daycase procedure ( no hospital over-night stay required), it is  well tolerated with minimal risks associated.

Response rates

Initial response rates are 70%.  In the longer term this procedure works in 50% of patients who continue to experience more than 50% benefit.  For approximately 3 months after the procedure the patient may experience increased pain, during this time extra analgesia may be required and I normally recommend physiotherapy.  The chance of being worse off in the longer term is less than 1%.  Patients may experience long term numbness and occasionally soreness in the back which is usually of no consequence.  Local anaesthetic and steroids are used to help cover post-operative soreness and these may cause headaches for a few days, occasionally associated with temporary weight gain.

Pulsed Radiofrequency Denervation to Suprascapular nerve:

This minimally invasive procedure is gaining popularity in the treatment of shoulder pain syndromes that are either non-amenable to surgery, or if the patient/surgeon requires a non-surgical option.  Using special needles, the nerve supplying sensation to the shoulder joint (suprascapular nerve) is stunned with a low-level electric pulse.  This changes the chemicals within the nerve which can produced prolonged pain relief.  As a non-surgical technique this procedure can be repeated in the future.