What Is A Thoracic Epidural Steroid Injection (ESI)?

The Epidural Steroid Injection is a procedure where numbing medicine (anesthetic) and anti- inflammatory medicine (steroid) is injected into the epidural space to treat pain caused by irritation of the spinal nerves. A protective covering called the dural sac surrounds the spinal cord. This sac contains spinal fluid that bathes and nourishes the spinal cord. The space between the outer surface of the dural sac and the bones of the spinal column is the epidural space. Nerves that go from the spinal cord, through the spinal column and to the body pass through the epidural space. Depending on the location of your pain, the epidural steroid injection can be given in the neck (cervical), middle back (thoracic) or lower back (lumbar).

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ESI Procedure Overview

The Epidural Steroid Injection is an outpatient procedure done in the Operating Room or a Special Procedure Room. For your safety and comfort, the doctor may decide to connect you to monitoring equipment (EKG monitor, blood pressure cuff, and a blood-oxygen monitoring device). In addition, the doctor or nurse may start an intravenous line and give some medicine to help you relax. Depending on the area to be injected, you will lie on your stomach or sit in a chair. After your skin is cleansed with an antiseptic solution the doctor will inject some numbing medicine that will produce a burning sensation for a few seconds. After the numbing medicine takes effect, the doctor will insert another needle and with the assistance of a special X-ray machine called a fluoroscope, inject a radiopaque dye (contrast solution) to confirm the needle is in the correct place. With the needle in position, the doctor will inject a mixture of numbing medicine (anesthetic) and anti-inflammatory medicine (cortisone / steroid). It is possible you will feel pain similar to your normal back pain as the medicine is injected. This is a good sign and means the medicine is going to the right place. The pain usually disappears quickly. After the procedure, we ask that you remain at the Clinic until the doctor feels you are ready to leave.

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Before and After the Procedure and the Risks

Before the Procedure

Since you will be receiving medication, it is recommended that you do not eat within four or five hours before the procedure. If you are a diabetic, be sure to discuss your eating and medication schedule with your doctor. You may need to stop taking certain medications several days before the procedure. Please remind the doctor of all prescription and over-the-counter medications you take, including herbal and vitamin supplements. The doctor will tell you if and when you need to discontinue the medications. It is very important to tell the doctor if you have asthma, had an allergic reaction (i.e. hives, itchiness, difficulty breathing, any treatment which required hospitalization) to the injected dye for a previous radiology exam (CT scan, angiogram, etc) or if you have had an allergic reaction to shellfish (shrimp, scallops, lobster, crab). The doctor may prescribe some medications for you to take before having the procedure. Tell the doctor if you develop a cold, fever, or flu symptoms before your scheduled appointment.

After the Procedure

You may experience some weakness and/or numbness in your legs (lumbar injection), arms (cervical injection), or chest wall (thoracic injection) for a few hours after the procedure. If so, do not engage in any activities that require lifting, balance and coordination. Drink plenty of clear liquids after the procedure to help remove the dye from the kidneys. Do not drive for the remainder of the day. Please have an adult drive you home or accompany you in a taxi or other public transportation. Depending on how you feel, you may resume normal activities and return to work the following day. If the doctor prescribes physical therapy, it is very important that you continue with the physical therapy program. Although you may feel much better immediately after the injection (due to the numbing medicine), there is a possibility your pain may return within a few hours. It sometimes takes a few days for the steroid medication to start working.

Procedure Risks

The risks, although infrequent, include: Allergic reaction to the medication; Nerve damage; Bruising at the injection site; Infection at the injection site; Puncture of dura resulting in a headache. If you experience severe back pain, new numbness, or weakness of your legs, a headache that will not go away or signs of infection in the area of the injection, you should call the doctor right away.