Thoracic Epidural Steroid Injection

The purpose of an epidural injection is to decrease pain, find out where the pain is coming from or both.  The medication is placed directly into the epidural space, which is outside the dura, a fluid filled sack that protects the brain, spinal cord and nerves. To ensure proper placement of the medication, the procedure is performed under fluoroscopic imaging, a low dose type x-ray.

These injections usually contain steroid and/or local anesthetic medications.  Steroid medication can reduce inflammation and pain from the disc, nerves and other structures.

Generally, these procedures are performed in the surgery center.  The patient will be asked to change into a hospital gown.  An IV may be started for medications and safety.  A brief pre-procedure history and physical examination are performed.  All patient medications taken at home will be reviewed to ensure there are no contraindications to the procedure and that the patient has complied with pre-procedure instructions.  The patient will be required to have a complete list of all medication normally taken at home.  The patient is then transported to the procedure room and positioned on an x-ray table.  The skin will then be cleaned with a sterile soap and draped in a sterile fashion.  The skin over the injection target site is then anesthetized with a local anesthetic.  Fluoroscopy is then used to guide a needle into the proper location.  Contrast dye is administered (unless the patient has allergies to iodine) to confirm placement and the medication is slowly injected.  Once the procedure is completed, the patient returns to the recovery area for approximately 30 minutes to rest.

The entire process for check-in, preparation, recovery and check-out will take 1-2 hours.  The procedure itself generally lasts for only 15 minutes, but the rest of the time is necessary to ensure a safe, efficacious procedure. During the injection, pain is sometimes increased temporarily.  Occasionally, patients may experience some temporary increase in pain for 2-3 days until the steroid medication takes effect, which is generally between 3 and 5 days after the procedure.

Every medical procedure, no matter how minor, contains some risks.  Anytime, a needle is placed into the body there is a risk of tissue injury, infection and bleeding.  If this occurs near the spine, it can result in nerve damage.  Although extremely rare, nerve damage and death have occurred following spine injections.  Injections near the spine also risk puncturing the dura and can result in headaches, which can easily be treated.  More common risks include a temporary increase in pain, local tenderness after the injection, allergic reactions to the medications and side effects from the steroids.

The patient will be asked to complete a pain diary after this procedure.  If sedation is administered, driving is prohibited for 24 hours and will require someone to accompany the patient home.  The patient should rest, if possible, the day of the procedure and can return to normal activities the following day.