If excellent pain relief is obtained from the first epidural injection, there will be no need to repeat it. If there is a partial benefit (greater than 30% relief from pain) the epidural injection can be repeated for possible additional benefit, or it may be necessary to conduct additional tests to more accurately determine what is causing the patient's pain. Up to three epidural steroid injections may be performed within a one-year period, spaced at least two to four weeks apart. If the initial injection provides minimal benefit (less than 30% pain relief) the physician may either repeat the injection, or try a different type of injection or treatment.
The treatment of an infection of the cervical spine depends on the severity of a patient's symptoms and severity of neurologic compression and bony destruction. Patients are initially referred for a fine needle aspiration (FNA) or closed bone biopsy and culture to ascertain the specific type of bacteria that is causing the infection. Patients in whom the biopsy or aspiration fails and the results are indeterminate may be considered for open biopsy. Patients are generally treated with strong antibiotics for 4-8 weeks until the infection is eradicated. Patients are usually indicated for surgical debridement if there is spinal instability, significant deformity, and/or neurologic deficit. A paravertebral abscess causing sepsis, or any sized epidural abscess, is often an indication for emergent surgical intervention. An anterior or posterior decompression and fusion, or a combined anterior/posterior surgery, may be utilized depending on where the infection and neurologic compression is most prominent.