Cervical Radiculopathy: Epidural Injection and Why Cathlab Safety Matters

Under international Spine Society guidelines, when the primary problem is pain alone, the patient does not need surgery, regardless of the degree of compression shown on imaging, as long as it is below L2. Surgery is indicated for disability: foot drop, motor deficit, sensory deficit, or more than moderate to severe canal stenosis on MRI, where an intervention can only buy time rather than treat the underlying disease. At Artemis, pain medicine and spine surgery work as a team. If a patient referred for pain turns out to have a neurological deficit, they go straight to the spine surgeon; if pain is the only presenting symptom, pain medicine treats it. The line between the two is clear.

If the femoral head itself is involved, radiofrequency ablation of the hip joint, targeting the genicular nerves supplying the joint, is a very rewarding procedure. But if the pain originates from the bone itself or has a visceral component, high-dose NSAIDs risk the kidneys and the better approach is opioid-based: morphine or tramadol with paracetamol and a neuropathic agent, alongside any specific interventional target that exists.

That is not something done from pain medicine. Deep brain stimulation is coming up fast as a field, but at Artemis it sits with the neurosurgery team, not pain medicine. That question is better asked at a neurosurgery masterclass.

First establish whether it is lateral or central canal stenosis, and check for any sensory or motor deficit on examination. Without a deficit and with lateral canal stenosis, transforaminal epidural adhesiolysis gives wonderful results. With moderate to severe central stenosis, a real sensory or motor deficit, and pain that does not respond to a block, the patient needs surgery.

Used for chronic low back pain, knee pain or similar musculoskeletal pain, yes, opioids are habit-forming. Used for cancer pain, and for sickle cell pain, which is managed on the same principles as cancer pain, they are never habit-forming in this experience. Opioids sit near the top of the WHO analgesic ladder, are safe on organ function, and are potent enough that patients do not become dependent in this context. Countries that prescribe opioids freely for ordinary chronic non-cancer pain, as parts of the United States and Europe have, do see patients become dependent. For routine non-cancer chronic pain, that risk is real and opioids should be avoided long-term.

No. Only a small minority of these patients, those with myelopathy or significant motor weakness, around 3% of cases, need surgery. The remaining 95 to 97% can be treated with a cervical epidural injection alone.

Because live imaging in a cathlab can reveal a complication, such as contrast dye tracking into an unexpected web of epidural veins, before it becomes dangerous. In one case, this catch is described as having potentially prevented a fatality on the table.

Dexamethasone combined with normal saline.