Cervical Epidural vs. Facet Joint Injections for Chronic Neck Pain: A Narrative Review

Chronic cervical pain is a significant source of disability and presents a multifaceted diagnostic and therapeutic challenge. With a global lifetime prevalence ranging from 26% to 71%, its economic and societal impact is substantial. Epidural steroid injections (ESIs) and cervical facet joint (FJ) injections are two common interventional pain management techniques used to address chronic neck pain, particularly when it originates from radicular pain, disc herniation, spinal stenosis, or facet syndrome. This narrative review, based on a comparative study, aims to synthesize the current understanding of these two procedures, including their anatomical considerations, indications, efficacy, and associated risks. The study's findings suggest that both cervical epidural and FJ injections are effective in providing pain relief and improving functional status in patients with chronic neck pain, with no statistically significant difference in pain intensity reduction or functional improvement observed between the two groups. However, safety profiles differ, with ESIs, particularly the transforaminal approach, being associated with a higher risk of serious complications, such as vascular trespass and spinal cord injury. The review highlights the importance of image guidance, patient selection, and a thorough understanding of cervical anatomy to mitigate risks. It concludes that FJ injections may represent a valid and safer alternative to ESIs for managing chronic cervical pain, especially in cases of low-to-moderate baseline pain.