Epidural Steroid Injection, Thoracic Spine

KEY FACTS

Terminology

• Injection of glucocorticoid/long-acting anesthetic into thoracic epidural space via interlaminar or transforaminal approach

Procedure

• Interlaminar epidural steroid injection (ESI)

  • Define margins of lamina and interlaminar space

• Transforaminal ESI

  • Ensure good visualization of neural foramen on true lateral view

• Benefit of CT

  • Improved visualization of osseous structures in severely osteopenic patients

  • Improved visualization of pleura/medial chest cavity

Post Procedure

• Expectation

  • Improvement in pain, or cessation of pain, following injection

• Things to do

  • Establish clinical follow-up, and have patient maintain pain diary

  • Remind patient to expect full benefit of injection over next 24-48 hours

Outcomes

• Most feared complications

  • Intraarterial injection: Spinal cord ischemia

  • Spinal cord puncture/hematoma

  • Compressive epidural hematoma

  • Pneumothorax

TERMINOLOGY