I have diagnosed as neck c5,c6 pivd and I have completed epidural steroid injections after 2yearsagain my pain started what to do
Reading File
Finding Sources
Finding Sources
Searching PubMed
cervical disc herniation C5 C6 recurrent pain treatment after epidural steroid injection
Searching the Web
C5 C6 PIVD pain recurrence after epidural steroid injection treatment options 2024
Finding Sources
Searching PubMed
cervical radiculopathy treatment recurrence surgery versus conservative
Finding Sources
Searching PubMed
cervical radiculopathy C5 C6 management ACDF conservative
Finding Sources
Searching PubMed
cervical disc herniation recurrent radiculopathy repeat epidural steroid injection surgery
Reading File
Finding Sources
I have enough information to give a thorough, well-structured answer. Let me compile it now.
C5-C6 PIVD with Recurrent Pain After Epidural Steroid Injections - What to Do
First, please understand: recurring pain 2 years after ESI is common and expected. Epidural steroid injections provide symptom relief but do not fix the underlying disc problem. Since pain has returned, this is a signal to re-evaluate your spine with a fresh approach and escalate care step by step.
Step 1: See Your Spine Specialist First (Urgent)
Before doing anything else, visit a spine surgeon or neurologist. You need:
- Repeat MRI cervical spine - to see if the disc herniation at C5-C6 has progressed, worsened, or if a new level is involved. A 2-year-old MRI is outdated for clinical decisions.
- Neurological assessment - check for new or worsening weakness, numbness, or reflex changes in your arms/hands. If you have progressive arm weakness, difficulty gripping, or any signs of myelopathy (clumsiness, difficulty walking, bladder/bowel changes), this needs urgent evaluation.
Step 2: Graded Treatment Options
A) Renewed Conservative Treatment (Start Here If No Red Flags)
| Treatment | What It Does |
|---|---|
| Physical therapy / cervical physiotherapy | Targeted exercises to strengthen neck stabilizers, traction, postural correction. Often the most durable long-term solution. |
| NSAIDs (e.g. ibuprofen, diclofenac) | Reduce nerve root inflammation and pain. Short-term use. |
| Neuropathic pain medications | Pregabalin (Lyrica) or gabapentin for burning/shooting arm pain. |
| Muscle relaxants | For associated neck muscle spasm. |
| Cervical traction | Mechanical or manual traction can open the neural foramen and relieve nerve root pressure. |
B) Repeat Injections
Since your last ESI was more than 12 months ago, clinically it is considered a new episode of pain, not a "repeat" injection. Guidelines (Carelon/AMA 2024) allow a new course of injections when the gap exceeds 12 months. Options include:
- Cervical interlaminar ESI (same as before, if it previously gave you 2 years of relief, it may work again)
- Transforaminal epidural injection at C5-C6 - more targeted to the specific nerve root, often more effective for single-level radiculopathy
- Selective nerve root block (SNRB) at C5 or C6 - diagnostic and therapeutic; confirms which nerve is the pain generator
- Pulsed radiofrequency (PRF) of the nerve root - a 2024 study found PRF of the selective nerve root was comparable to ESI for cervical radicular pain, with potentially longer duration of relief
C) Minimally Invasive / Interventional Options
If injections fail again or provide only short relief:
- Cervical radiofrequency ablation - for facet joint pain component (more useful if your pain is axial/neck pain rather than arm pain)
- Platelet-rich plasma (PRP) / PRGF injections - emerging evidence; a 2021 study showed benefit for cervical and lumbar back pain
D) Surgery (When Conservative & Injection Therapy Fails)
Surgery is generally considered when:
- Conservative treatment has failed for 6-12 weeks
- Injections no longer provide adequate relief
- Progressive neurological deficit (weakness, reflex loss)
- Signs of cervical myelopathy
Surgical options for C5-C6 PIVD:
| Surgery | Details |
|---|---|
| ACDF (Anterior Cervical Discectomy and Fusion) | Gold standard for C5-C6. Removes the disc, decompresses the nerve root, and fuses the segment. Success rates >85-90% for radiculopathy. |
| Posterior cervical foraminotomy | Keyhole surgery from behind to open the foramen; avoids fusion and preserves motion. Good for lateral disc herniations. |
| Cervical disc arthroplasty (artificial disc) | Alternative to fusion; preserves motion at C5-C6. Evidence supports equivalent or better outcomes vs. ACDF for radiculopathy. |
Step 3: What NOT to Do
- Do not ignore progressive arm weakness, grip weakness, or changes in fine motor function - these are surgical urgency signals.
- Do not try to manage this without imaging - MRI is necessary to guide any further treatment.
- Do not rely on painkillers alone long-term without addressing the underlying disc issue.
Red Flags - Go Immediately to Emergency If You Have:
- Sudden severe weakness in arms or legs
- Difficulty walking or balance problems (myelopathy)
- Loss of bladder or bowel control
- Severe pain after trauma/fall
Summary Roadmap
Recurrent C5-C6 pain
→ Repeat MRI + Neurological exam
→ No deficit / mild symptoms → Physiotherapy + Medications + Repeat ESI
→ Failed injections → Targeted nerve root block / PRF
→ Progressive deficit or failed all conservative → Surgical consultation (ACDF / foraminotomy)
The good news is that since you had 2 full years of relief from your previous ESI, your nerve root is likely still functional and responsive to treatment. Many patients in your situation do well with a repeat injection course combined with a structured physiotherapy program. Surgery is an option but usually reserved for those who fail this pathway.
Important disclaimer: This information is for general guidance only. Please consult your treating spine surgeon or pain specialist before making any treatment decisions. Your doctor needs to examine you and review updated imaging before recommending the right next step for your specific situation.
This is a shared conversation. Sign in to Orris to start your own chat.