Thoracic epidural steroid injections are used to treat the mid back pain caused by various spinal disorders. These disorders include spinal stenosis, thoracic radiculopathy, thoracic disc pain, osteoarthritis, and herpes zoster. Herpes zoster, known colloquially as shingles, is a viral disease characterized by painful blisters on the skin. If a patient is still suffering from residual pain long after the shingles rash has cleared up, steroid injections are an effective way to manage it. Thoracic epidural steroid injections are often used when conservative measures such as ice packs and physical therapy fail to eliminate mid back pain.
Details of the Procedure
During the thoracic epidural steroid injection procedure, the patient either sits or lies face down to expose the middle of the back. The injection site is cleaned and sterilized, and a local anesthetic is applied to numb the tissue. The epidural needle is then inserted into the affected area using an X-ray device called a fluoroscope as a visual guide. A pharmaceutical liquid called contrast dye is used to improve the visibility of the injected medicine and internal tissue in the X-ray images. Once the needle is placed in the appropriate area, a corticosteroid and anesthetic mixture is injected. The anesthetic reduces mid back pain immediately, and the steroid is released over time to provide an anti-inflammatory effect. At the end of the procedure, the doctor removes the needle and covers the injection site with a bandage.
Benefits of Thoracic Epidural Steroid Injections
Epidural steroid injections are a safer and less invasive alternative to surgery when dealing with thoracic pain. Surgical procedures are also more costly and typically result in a longer recovery time. Many patients notice a significant reduction in pain after their first injection. The pain relief typically sets in within five to 10 days as the steroid begins to take effect. Patients who do not experience pain relief after the first injection may need to repeat the procedure.
Puncturing of the dural membrane that surrounds the spinal column is one of the more common risks associated with epidural injections, occuring in less than 1% of cases. Puncturing this tissue leads to symptoms such as headaches and nausea that typically worsen when the patient stands or sits upright. These symptoms should fade after a few days. In extremely rare cases, spinal nerves and other tissue may be damaged by the epidural needle. As with any injection, the treatment area is prone to bleeding and bacterial infections. The steroid used in the procedure may cause side effects such as flushing of the face, increased blood pressure, and weight gain.
After the procedure, pain in the affected area may become worse for one or two days. Using heat packs on the area may exacerbate the inflammation, but icing is typically safe and effective. Patients should plan to get a ride home and avoid driving for at least 24 hours. Physical activity can be gradually increased to normal levels after a week or so. A physical therapy routine may be prescribed to reduce pain and shorten the recovery period.