Thoracic Epidural Steroid Injection

WHAT IS THE EPIDURAL SPACE?

The dura is a protective covering of the spinal cord and its nerves. The space surrounding the dura is called the epidural space. In the upper back, it is called the thoracic epidural space.

WHAT CAUSES PAIN IN THE EPIDURAL SPACE?

The thoracic area of the spine has twelve bones, called vertebrae. Soft discs found between them cushion them, hold them together, and control motion. If a disc tears, chemicals inside may leak out. This can inflame the dura or nerve roots and cause pain. A large disc tear may cause a disc to bulge, inflaming the dura and nerve roots, and cause pain. Bone spurs, called osteophytes, can also press against nerve roots and cause pain.

HOW DO I KNOW IF I HAVE DISC AND NERVE ROOT PAIN?

If you have pain in your upper back when you move, you may have disc or dural inflammation. If pain travels to the front of your chest when you move your upper back, you may have nerve root inflammation. Common tests such as MRIs can show disc bulges and nerve root compression, but may not always show a torn and leaking disc. A thoracic epidural injection can help find out if disc, dural, or nerve root inflammation is causing your pain.

WHAT IS A THORACIC EPIDURAL STEROID INJECTION?

During this procedure, a local anesthetic (numbing medicine) and a corticosteroid (anti-inflammatory medicine) are injected into the epidural space to reduce inflammation. Your physician may inject into this space from behind. This is called an interlaminer injection. When your physician goes in from the side, it is called a transforaminal injection. If the needle is positioned next to an individual nerve root, it is called a selective nerve root block.

WHAT HAPPENS DURING AN INJECTION?

A local anesthetic may be used to numb your skin. The doctor will then insert a thin needle directly into the epidural space. Fluoroscopy, a type of x-ray, may be used to ensure the safe and proper position of the needle. A dye may also be injected to make sure the needle is in the correct spot. Once your physician is sure the needle is correctly placed, the medicine will be injected.

WHAT HAPPENS AFTER AN INJECTION?

You will be monitored for up to 30 minutes after the injection. When you are ready to leave, the clinic will give you discharge instructions. You will be monitored for up to 30 minutes after the injection. Before you leave, the clinic will give you discharge instructions as well as a pain diary. Keeping track of your pain helps the doctor know what the next steps will be. You may want to check for pain by moving your back in ways that hurt before the injection, but do not overdo it. You may feel immediate pain relief and numbness in your back and leg for up to six hours after the injection. This means the medication has reached the right spot. Your pain may return after this short pain-free period, or may even be a little worse for a day or two. This is normal. It may be caused by needle irritation or by the steroid itself. Steroids usually take two or three days to start working, but can take as long as a week. You should be able to return to work the day after the injection, but always check with your doctor.

HOW LONG CAN I EXPECT PAIN RELIEF?

Depending on the amount of inflammation, an injection could offer several months of pain relief before further treatment is needed. For some, a single injection could result in long-term pain relief. If your pain is caused by injury to more than one area, only some of your symptoms will be helped by a single injection.

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