What is the epidural space?

The dura is a protective covering of the spinal cord and its nerves. The space surrounding the dura is the called the epidural space, in the lower back this is known as the lumbar epidural space.

 What causes pain in the epidural space? 

The thoracic area of the spine has 12 bones, called vertebrae. Soft disks found between these vertebrae cushion them, hold them together, and control motion. If a disk tears, chemicals inside may leak out. This can inflame the nerve roots or the dura and cause pain. A large disc tear may cause a disc to bulge, inflaming or compressing nerves, and inflaming the dura, and causing pain. Bone spurs, called osteophytes, can also press against nerve roots and cause pain.

How do I know if I have disc and nerve root pain?

If you have pain in your upper back when you bend your back, you may have thoracic disc and dural inflammation. If pain travels to the front of your chest when you move your upper or mid back, you may have nerve root inflammation. Common tests such as MRIs can show disc bulges and nerve root compression, but may not show a torn and leaking disc. A thoracic epidural injection may provide relief if disc problems, dual inflammation,  or nerve root inflammation are causing your pain.

What is a thoracic epidural steroid injection?

In a thoracic epidural steroid injection, a corticosteroid (anti-inflammatory medicine) is injected into the epidural space to reduce inflammation. Your physician may inject into is the epidural space from behind; this is called an interlacing injection.  When it is done from the side where the nerve exits the spine, it is called a transforaminal injection.  If the needle is positioned next to an individual nerve route, it is called a selective nerve route block.

What happens during an injection?

A local anesthetic will be used to numb your skin. The doctor will then insert a small needle directly into the epidural space. Fluoroscopy, a type of X-ray, will be used to ensure the safe and proper position of the needle. Dye will also be injected to make sure the needle is at the correct spot. Once the doctor is sure the needle is correctly placed, the medicine will be injected.

 What happens after an injection?

You will be monitored  For up to 30 minutes after the injection. When you are ready to leave, the staff will give you discharge instructions. Take it easy for the rest of the day. You will also receive a pain diary. It is important to fill this out because it helps your doctor know the injection is working. It will help to move your upper back in ways that hurt before the injection. You may feel immediate relief and numbness in your upper and mid back for a period of time after the injection. This may indicate the medication has reached the right spot. Corticosteroids may take 2 or 3 days to start working, but may take as long as a week. You can usually return to work the day after the injection, but always check with your doctor.

How long can I expect pain relief?

The extent and duration of pain relief may depend on the amount of the disc, dural, or nerve root inflammation. Other coexisting factors may be responsible for your pain. Sometimes an injection brings several weeks to months of pain relief, and then further treatment is needed. Other times, a single injection brings long term pain relief. If your pain is caused by an injury to more than one area, only some of your symptoms will be helped by a single injection.

This information has been provided by your doctors so you can better understand this procedure. Your doctor will make the next best recommendation for your specific needs. This article is for general education only. Specific questions or concerns should always be directed to your doctor. Your doctor can explain possible risks or side effects.

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