In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss a how a needle may go down in history for changing the course of the 2019 World Series!

This needle was brought into the national spot light during the World Series between the Washington Nationals and Houston Astros, when one of the starting pitchers for the Nationals (Max Scherzer) developed severe neck pain and muscle spasms and was unable to use his arm. Max Scherzer is known for his fierce competitive nature, and he was determined to return to help his team.  He underwent a cervical epidural steroid injection and aggressive treatment on his neck by the whole rehabilitation team, and was able to return to pitch in the deciding game 7 of the World Series and pitched 5 innings with 2 earned runs.  The Nationals went on to win in historic fashion bringing home their first World Series title.

The doctors will dive deeper into this specific image guided therapeutic injection, the cervical epidural steroid injection.  The cervical epidural steroid injection is a fluoroscopy (Xray) guided therapeutic injection that is performed to deliver anti-inflammatory pain medication (steroid medication) to a specific location in the cervical spine (epidural space) in order to treat certain neck pathologies (most commonly cervical radiculopathy or radiculitis).  For patients who have moderate to severe neck pain, due to certain processes including cervical radiculopathy/radiculitis,  that is not improving and not responding to lifestyle modifications, activity modifications, physical therapy, medications, and other conservative measures, it is reasonable to consider an epidural steroid injection.

Referenced in the discussion are the most recent systematic reviews, that show at least level 2 evidence that cervical epidural steroid injections improve pain and function for neck and upper extremity pain due to certain processes including but not limited to cervical radiculopathy/radiculitis (Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review. Manchikanti et al. Pain Physician. 2015.) Prior to consideration of surgery (assuming no red flag signs/symptoms requiring more urgent/emergent surgical intervention), cervical epidural steroid injections should be considered to improve function, pain, and ultimately overall health long term.  

 

Cervical epidural steroid injections will most likely not result in you or your patients winning championships, but they are an important and effective treatment option when considering treatment for cervical pathology, especially when dealing with cervical radiculopathy or radiculitis.  

This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.