Background and Aims Compressive cervical radiculopathy commonly causes arm pain with or without sensory and motor dysfunction. Trans-foraminal and intra-laminar steroid epidurals are the standard interventional management of cervical pain. They are also used as a prerequisite for surgical options. However, these procedures can cause severe complications, including infection and neurovascular injury. The trans-facet technique is an underutilized and underreported but safer and effective alternative compared to trans-foraminal and intra-laminar injections. This approach provides an avascular site and avoids neurological structures, preventing severe complications. Limited literature has shown trans-facet injections are equally successful. Our case highlights that transfacet epidural steroid injections are safe and therapeutic for cervical neuralgia.

Methods A 24-year-old female presented with moderate to severe neck pain caused by a recent motor vehicle accident. The pain was sharp, worse on the left side, radiated to the elbow, and exacerbated her chronic migraines. Her quality of life was significantly affected. She was conservatively managed with over the counter pain medication. MRI of the cervical spine showed mild to moderate stenosis on the left at C4–5 and C5–6. Under fluoroscopy, a trans-facet epidural steroid injection was delivered at the left C4–5 level. Postoperatively, at day 1 and 14, the patient reported significant pain relief with no complications.

Conclusions Transfacet epidural steroid injections are potentially safer and equally effective interventional technique for cervical radicular pain. This practice can be the safest way to administer steroids into the epidural space by avoiding neurovascular structures. Using this technique, providers can prevent catastrophic outcomes that can significantly debilitate patients.