02/02/2026
Standard of Care Spotlight: Cervical Epidural Steroid Injections (CESIs)
Expert witness work requires staying current with evidence-based medicine and evolving standards of care. This year we are starting a new series, called Standard of Care Spotlight, where we will share practical insights from real case reviews.
Today’s focus is cervical epidural steroid injections (CESIs), a procedure frequently examined in malpractice cases, often involving avoidable safety deviations.
A key reference is the Multi-Society Pain Work Group’s Epidural Steroid Injection Safety Recommendations (2014), developed by 14 medical societies and outlining 17 evidence-based safety guidelines.
Below are the three most common violations seen in litigation:
1. Moderate or Deep Sedation – Avoid heavy sedation. Patient feedback is a key safety signal; sedation can hide warning signs and increase risk of spinal or vascular injury.
2. Injection Above C6–C7 – Cervical injections should be at C6–C7 or below. Higher levels narrow the epidural space and increase the risk of cord injury.
3. Particulate Steroids – Use only non-particulate steroids (e.g., dexamethasone). Particulate steroids risk catastrophic vascular events, including stroke or paralysis.
Bottom line: CESIs can be safe, but only when performed in strict alignment with established standards of care.
Follow along for more insights from ongoing expert witness work. If expert medical review or testimony is needed, Expert Witness Pain is here to help.
Learn more at: https://expertwitnesspain.com