Thoracic Epidural Steroid Injection

What is the epidural space?

The membrane that covers the spinal cord and nerve roots in your spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space into your mid back and along the ribs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact with the bony structure of the spine in some way.

What is an epidural and why is it helpful?

An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in your mid back and rib cage. The epidural injection may help the injury to heal by reducing the inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of your pain is healing.

What will happen to me during the procedure?

An IV will be started so that relaxation medication can be given. You will be placed on the X-ray table on your stomach in such a way that your doctor can best visualize your back using x-ray guidance. The skin on the your back will be scrubbed with two types of sterile (soap) scrub. Next, the physician will numb a small area of skin with numbing medicine. The medicine stings for several seconds. After the numbing medicine has been given time to be effective, your doctor will direct a very small needle using x-ray guidance into your neck. A small amount of contrast (dye) is then injected to insure proper needle position inside the joint space. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) will be injected.

What will happen after the procedure?

Immediately after the procedure, you will move around and try to imitate something that would normally bring about your usual pain. You will then be sent to the recovery area to be monitored for 30-60 minutes. You will then report the percentage of pain relief and record the relief you experience during the next week on a post injection evaluation sheet (diary). This will be given to you when you are discharged home.

You will not be able to drive the day of your procedure. You may be referred to a chiropractor or physical therapist immediately afterwards while the numbing medicine is still working.

General Pre/Post Instructions

If you are going to have anesthesia you need to be fasting for eight (8) hours prior to the injection. If you have having local anesthesia you should eat a light, but not a full meal within a few hours before your procedure. If you are an insulin dependent diabetic, do not change your normal eating pattern prior to the procedure. Please take your routine medications (i.e. high blood pressure and diabetic mediations). Do not take pain medication or anti-inflammatory medications the day of your procedure. You need to be hurting prior to this procedure. Please do not take any medication that may give your pain relief or lessen your usual pain. These medicines can be restarted after the procedure if they are needed.

If you are on Coumadin or Heparin (blood thinners) or Glucophage (a diabetic medicine) you must notify this office so the timing of stopping these medications can be explained. You will be at the office at least two (2) hours for your procedure. You will need to bring a driver with you. You may return to your normal activities the day after the procedure, including returning to work.

If you are unable to keep this appointment, please give notice as soon as possible and at least 24 hours in advance. Thank you.