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What is a Thoracic Interlaminar Epidural Steroid Injection?

A thoracic interlalminar epidural steroid injection is a simple procedure for treating pain in the upper back, ribs and abdomen. It is an injection of an anti-inflammatory steroid (e.g., Celestone or Decadron) in the epidural space. The epidural steroid injection is not an injection into the spinal cord itself. The spinal cord and spinal nerves are in a “sack” containing clear fluid (cerebrospinal fluid). The area outside this “sack” is called the epidural space. An epidural steroid injection is not the same injection as a labor epidural, which is commonly given to women in labor.

What is a Thoracic Transforaminal Epidural Steroid Injection?

A thoracic transforaminal epidural steroid injection isthe same as an interlaminar epidural steroid injection except,  when it is done from the side where the nerve exits the spine, it is called a transforaminal injection.

Why is it done?

When the nerves in the epidural space are irritated or pinched by a bulging disk, narrowed “nerve canal” or bone spur, the resulting inflammation can cause pain, numbness, or tingling. The steroid injected can reduce inflammation of nerves in the epidural space and thus reduce pain and other symptoms.

How long does it take to do?

The actual injection takes only a few minutes. Please allow about an hour for the procedure; this will include talking to your doctor before the procedure, signing the informed consent, positioning in the room, and observation by the recovery room nurse afterwards.

What medicines are injected?

The injection consists of a mixture of local anesthetic (e.g., Bupivacaine or Lidocaine) and the steroid medication (such as Celestone or Decadron).

Will it hurt?

All of our procedures begin by injecting a small amount of local anesthetic through a very small needle. It feels like a little pinch and then a slight burning as the local anesthetic starts numbing the skin. After the skin is numb, the procedure needle feels like a bit of pressure at the injection site. You also have the option of adding some oral or intravenous sedation.

Will I “be asleep” for this procedure?

This choice is yours. You can choose to have the procedure done under local anesthetic only. You can also choose to have IV sedation, which can keep you very comfortable. It can range from some drowsiness or you may have little or no memory of the procedure depending upon your comfort level, regardless of the amount of sedation, you must not eat or drink anything for 6 hours prior to this and you must also have a driver when choosing sedation. It is OK to take your medications with a sip of water with either decision.

How is it done?

It is typically done with you lying on your stomach. Your blood pressure and oxygenation will be monitored. In addition to your doctor and the x-ray technician, there will be a nurse in the room at all times if you have any questions or discomfort during the procedure. The skin on the back is cleaned with antiseptic solution and then the procedure is done.

What should I expect after the injection?

Immediately after the injection, you may feel your legs becoming slightly heavy or numb. You may notice that your pain may be gone or considerably less. This is due to the effect of the local anesthetic and lasts only for a few hours. Your pain may return and you may have some soreness at the injection site for a day or so. You should start noticing pain relief starting about 1-2 days after the procedure.

What should I do after the procedure?

We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Your recovery room nurse will advise you about applying ice to the site.

Can I go back to work the same day or the next day?

You should be able to unless the procedure was complicated. Your doctor or recovery room nurse will discuss this with you.

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