Thoracic Epidural Steroid Injections in NYC

An epidural steroid injection is an effective non-surgical treatment intended to treat pain in a particular region of your body, from your neck to your tailbone. The thoracic epidural steroid injection relieves upper back pain shooting around your chest caused by irritated and inflamed pinched nerves.
The procedure involves injecting a local anesthetic (numbing medicine) and steroid medication into the epidural space through which the inflamed nerves travel. The epidural space is located outside the outermost layer enveloping your spine.

An epidural works by alleviating inflammation (swelling) of the nerve roots as they exit your spine. These nerves go through the epidural space to your upper back and chest. Inflammation of these nerve roots can be caused by a herniated disc or narrowing of the areas within your spine.
Steroids are anti-inflammatory agents. By delivering an anti-inflammatory medication directly into the epidural space, the epidural injection reduces the inflammation of the nerve roots.

The epidural steroid injection is performed in the office in our X-ray room.

A thin, flexible needle is inserted through your upper back, slightly off the midline, to reach the epidural space, which contains inflamed and irritated nerve roots.

An epidural shot can treat several conditions that cause upper back or chest pain due to nerve irritation. The common conditions that epidural injections treat are disc herniation, thoracic stenosis, and facet joint arthritis. Thoracic disc herniation is when your disc’s inner, jelly-like core forces through the outer ring into the spinal canal. This may be compressing your spine and nerves, which triggers nerve root pain spreading around your chest(known as radicular pain). Thoracic spinal stenosis is narrowing your spinal canal (that contains the nerve roots and spinal cord) in the thoracic area. It gives rise to pain in the upper back and tingling in the chest, especially if you are sitting for a long time. Facet joint arthritis is when your small joints between two spinal bones (facet joint) develop inflammation, causing upper back pain that can go around your chest.

We use a specialized X-ray (called fluoroscopy) with a special laser to guide the needle into the right spot. You will lie on an x-ray table on your stomach. After thoroughly cleaning, a local anesthetic is first used to numb the targeted site. The site is targeted by lasers, which we use throughout the procedure to guide the needle precisely where it needs to be. A needle is then inserted into the epidural space with an x-ray fluoroscopy. Fluoroscopy directs the needle to reach the targeted spot by enabling the doctor to view and adjust the position of the needle in real time on an x-ray monitor. Once the needle is in the proper place, as seen on the monitor, contrast (dye) is injected to verify the needle’s location and guide the steroid to the desired site. The steroid is then slowly injected with the anesthetic to help minimize swelling around nerve roots and relieve the pain. The needle is then finally removed. The whole procedure will occur for 5-6 minutes.

Following the procedure, we will monitor you for potential complications for about 15 to 20 minutes before discharge.

Epidural steroid injections are generally considered a safe and effective treatment for back and leg pain, mid-back pain, or neck and arm pain. Serious adverse events are rare but could include bleeding, infection, or nerve damage. We greatly minimize these risks by using live fluoroscopy, laser guidance, and contrast dye to place the needle in the epidural space accurately.

Some patients experience soreness in the treated area. This pain usually occurs when the local anesthesia wears off while the steroids have not started to take effect yet. You can manage this soreness by applying ice packs and taking a low dose of Tylenol. Rare complications include bleeding, infection, and headaches. Side effects of steroids are “Steroid flush” or transient flushing of the face and chest, raised blood sugars, sleep issues, menstrual problems in women, and water retention. These side effects are rare since we use a small number of concentrated steroids. The side effects resolve within 2-3 days without any treatment.

Epidural injections do not cause weight gain. However, long-term use of high-dose steroids has widespread adverse effects on almost all your body systems, including body weight. This is why we limit the number of epidural steroid shots a person can receive in a year.

Epidural steroid shots are successful in the most upper back or chest patients. The steroid injection can take as long as 2-10 days. You may have slightly increased pain at the injection site during this period until the steroid medication kicks in. You are asked to take it easy on the day of the procedure. You will be okay to resume all your regular activities the following day.

After your discharge, it’s best to rest and relax for the rest of the day. If you have pain at the injection site, apply an ice pack to that area. You can resume all normal activities the next day.

You may shower on the same day. However, avoid soaking in a bathtub, using a hot tub or sauna, or swimming for at least two days after your procedure.

All insurances cover epidural injections, especially if you have a lot of pain that has not been getting better with conservative treatment like non-steroidal anti-inflammatory drugs (like ibuprofen), exercise therapy, and lifestyle modifications.

An epidural steroid injection can be given 3-4 times per 12-month period. By optimizing the first epidural to be as effective as possible, we try to avoid repeating the injection. We only repeat the procedure if there is a need to, which will be discussed during your follow-up visit.