What is a Thoracic Epidural?

A thoracic epidural steroid injection is an injection that goes into the spinal nerves in your middle and upper back. It aims to manage chronic pain caused by irritation and inflammation of the spinal nerves in your middle or upper back due to certain conditions or injuries. This type of pain typically radiates from your middle back to your hips, legs and feet. A thoracic epidural is not meant to cure middle back pain, rather help to provide pain relief to improve quality of life.

During an epidural, your provider injects a steroid into the epidural space around your spinal cord. This space acts as a sleeve and contains things like fat, spinal nerves, blood vessels, and connective tissue. The steroid allows for focus on reducing swelling and pressure on the irritated nerves.

Causes for a Thoracic Epidural

Cervical epidurals are used to treat a type of pain known as cervical radiculopathy, caused by spinal nerve root inflammation in your neck. The most common symptoms associated with this are pain, numbness, muscle weakness or tingling in your low back down your leg into your foot. Many conditions can irritate your lower back spinal nerves, including:

• Thoracic herniated disc – often called a ruptured or bulging disc. Overtime, the outer layer of the soft, gel-like centers of the disc can dry out, causing it to weaken and crack. A herniated disc occurs when the gel pushes through a crack in one of the discs between two vertebrae in your low back. This may irritate or pinch nearby nerves.
• Thoracic degenerative disc disease – occurs when the cushioning between your vertebrae in your low back begins to wear away.
• Thoracic spinal stenosis – occurs due the narrowing of one or more spaces within the lumbar spine, reducing the amount of available space for spinal nerves. This leads to irritation or pinching of the nerves.
• Thoracic osteoarthritis – also known as lumbar spondylosis, this involves changes to the bones, discs and joints caused by the normal wear and tear of aging. This can lead to narrowing of the spine, causing inflammation, and pinching of the nerves.

Benefits of a Thoracic Epidural

After an evaluation, your provider may recommend a thoracic epidural to manage your pain. The five vertebrae in your spine have several important roles, including:

• Supporting your chest and abdomen.
• Providing attachment for your ribs.
• Allowing for twisting and bending movements.
• Protecting your spinal cord and cauda equina (the nerves that extend from the bottom of your spinal cord).

When you experience middle or upper back nerve pain, these functions can be affected. Thoracic epidurals most often lead to temporary pain relief that lasts for three months or more. Some people may experience less or no pain relief from the injection.

Successful thoracic epidurals can have several positive benefits, including:

• Temporary pain relief.
• Better quality of life and improved ability to do daily activities.
• Reduce or eliminate the need for surgery.

How Does a Thoracic Epidural Work?

Thoracic epidurals are very precise, so your provider will give you specific instructions about what you need to do to prepare. Be sure to tell your healthcare provider if you are pregnant or may be pregnant due to the fluoroscopy imaging usage of dye during the procedure. Your provider may:

• Limit your eating or drinking a certain amount of time prior to the procedure.
• Adjust certain medications.
• Request additional scans as needed.

In most cases, a thoracic epidural takes around 15 to 30 minutes. There are different methods in which your provider can access the spinal cord, including:

• Interlaminar – the path of the needle goes between two laminae (a flat bone that is part of each vertebra) in your spine to reach the epidural space. 
• Transforaminal – the path of the needle goes through the foramina, which are openings through which nerve roots exit your spine.
• Caudal – the path of the needle goes through the sacral hiatus, the lowest part of your sacrum. 

Using a fluoroscopy, your provider will guide the needle to the appropriate place in the back. Local anesthesia may be injected near the area of the epidural to reduce pain. When the needle is in place, a contrast will be injected to ensure the needle tip is in the right place. Your provider will then slowly inject the medication. This usually includes a mixture of anti-inflammatory medications, such as steroids or corticosteroids. Slight pressure, tingling or burning can occur during the procedure, however some people don’t feel anything. If you feel intense, sharp pain during or after the procedure, tell your provider immediately.

You may experience a temporary increase in pain before the medication begins to kick in. Tenderness and bruising at the site of injection is considered normal.

Risks of a Thoracic Epidural

As with any procedure, a thoracic epidural carries certain risks and complications. Although rare, they can include:

• Low blood pressure
• Severe headache caused by spinal fluid leakage.
• Infection
• Negative reaction to the medications.
• Bleeding or blood clots.
• Damage to nerves at the injection site.
• Temporary loss of control of bladder or bowels.

While it is very rare, thoracic epidurals can have potentially long-term complications, including:

• Permanent neurologic deficit due to spinal cord or nerve damage.
• Chronic pain.
• Permanent paralysis from a hematoma.

Some people experience pain relief for up to 12 months, while others don’t experience pain relief at all. If a thoracic epidural doesn’t work for you, your healthcare provider may recommend other forms of treatment for treating your neck pain. It is important to remember that thoracic epidurals are not intended to cure your back pain, rather help provide relief. 

Contact your healthcare provider immediately if you experience any of the following after your procedure:

• Severe headache while standing or sitting that feels better after lying down.
• Fever
• Reduced or complete loss of bladder or bowel function.
• Numbness or weakness in your legs.