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Thoracic Transforaminal Epidural Sterod Injection

What does Thoracic Transforaminal Epidural Steroid Injection mean?

Here is what each word means:

  1. Thoracic: the parts of the spine located in the mid-back
  2. Transforaminal: through a foramen (the opening for the spinal nerve to leave the spine)
  3. Epidural: a space outside of the lining of the spinal cord, spinal fluid and spinal nerves
  4. Steroid: a powerful anti-inflammatory medication sometimes called “cortisone”

Altogether, “Thoracic Transforaminal Epidural Steroid Injection” means injecting a powerful anti-inflammatory medication through the opening on the side of a vertebra in the mid-spine.

Why is a Thoracic Transforaminal Epidural Steroid Injection done?

A Thoracic Transforaminal Epidural Steroid injection is a procedure often done as a treatment for pain stemming from disc herniations in the mid-back. The disc herniation often results in inflammation the spinal nerve next to it, resulting in back and chest pain. This inflammation is the target of the procedure.

What is the difference between a Thoracic Interlaminar Epidural Steroid Injection, a Thoracic Transforaminal Epidural Steroid Injection, and a Thoracic Nerve Root Block?

All three injections are often done for an inflamed disc and spinal nerve in the mid-back, most commonly due to a disc herniation. The difference between them is where the medication is delivered. Some of this may depend on the location of the disc herniation or the preference of the doctor performing the injection.

Here is where each injection delivers the medication:

  1. Thoracic: Interlaminar Epidural Steroid Injection:

The medication is injected into the main epidural space on the back of the spine, just outside the spinal cord and its lining (dura). The medication usually spreads over a wide area, i.e. multiple spinal nerves and discs.

  1. Thoracic Transforaminal Epidural Steroid Injection:

The medication is injected through the foramen (opening for the spinal nerve to leave the spine), i.e. right next to the inflamed nerve. The medication usually does not travel very far outside of the area around the spinal nerve.

  1. Thoracic Nerve Root Block

This injection is very similar to the Thoracic Transforaminal Epidural Steroid Injection. The difference is that the medication is placed onto the nerve outside the foramen, i.e. once the nerve has left the spine.

How is a Thoracic Transforaminal Epidural Steroid Injection done?

Here are the steps of how a Thoracic Transforaminal Epidural Steroid Injection is done:

  1. The procedure is usually done in a Procedure Room or Operating Room.
  2. The patient may receive relaxing medication (sedation) either by mouth or with an intravenous catheter (IV).
  3. The patient is placed on the stomach (prone)
  4. The mid-back (thoracic spine) is cleaned with a surgical antiseptic and sheets (drapes) are used to keep the area clean.
  5. The doctor will then inject a small amount of a local anesthetic under the skin.
  6. Next, a specialized needle (spinal or procedure needle) is placed through the anesthetized area.
  7. At this point, typically an X-Ray machine is used to see the tip of the needle as it is slowly advanced towards the foramen (hole for the spinal nerve).
  8. When the needle tip appears to be in a good position close to or barely in the foramen, a small amount of contrast material (fluid which looks dark on an X-Ray) is injected through the needle to verify that it is in the correct location.
  9. Next, a mixture of medication is injected into the epidural space. This mixture may consist of a steroid, a local anesthetic, a pain killer or a combination of these medications.
  10. The needle is withdrawn.
  11. A band-aid is placed at the site of the needle puncture.
  12. The patient is then taken to a Recovery Area for a period of observation.

How long does it take to do this procedure?

Typically a Thoracic Transforaminal Epidural Steroid Injection takes about 5-10 minutes to complete.

What benefit can patients gain from a Thoracic Transforaminal Epidural Steroid Injection?

The relief from spine injections can vary. If the injection is done for an inflamed spinal nerve, the relief can be substantial or complete. It could last as long as 3-6 months.