Thoracic Epidural Injections

2018 ◽  
pp. 187-208
Author(s):  
Laxmaiah Manchikanti ◽  
David M. Schultz ◽  
Scott E. Glaser ◽  
Frank J. E. Falco
Keyword(s):  
Thoracic Epidural ◽  
Epidural Injections

scholarly journals A Systematic Evaluation of Thoracic Interlaminar Epidural Injections

2012 ◽  
Vol 4;15 (4;8) ◽  
pp. E497-E514
Author(s):  
Ramsin M. Benyamin
Keyword(s):  
Systematic Review ◽  
Back Pain ◽  
Randomized Trial ◽  
Spinal Stenosis ◽  
Pain Syndrome ◽  
Epidural Injection ◽  
Thoracic Pain ◽  
Discogenic Pain ◽  
Thoracic Epidural ◽  
Epidural Injections

Background: There is a paucity of literature on the use of epidural injections for the treatment of chronic mid and upper back pain due to disc herniation and radiculitis, axial or discogenic pain, spinal stenosis, post surgery syndrome, and post thoracotomy pain syndrome. Study Design: A systematic review of therapeutic thoracic epidural injection therapy for chronic mid and upper back pain. Objective: The objective of this systematic review is to determine the effects of thoracic interlaminar epidural injections with or without steroids, with or without fluoroscopy, and for various conditions including disc herniation and radiculitis, axial or discogenic pain, spinal stenosis, post thoracic surgery syndrome, and post thoracotomy pain syndrome. Methods: The available literature on thoracic interlaminar epidural injections with or without steroids in managing various types of chronic mid and upper back pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, or limited (or poor) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to March 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this review, 17 studies were identified, including studies examining adverse reactions. Only 2 studies were included: one randomized trial and one non-randomized or observational study. The results of this systematic review evaluating the effectiveness of thoracic epidural injections with or without steroids in managing chronic thoracic pain shows fair evidence with one randomized trial in patients with various causes; whereas the evidence is limited based on one non-randomized study evaluating chronic pain in post thoracotomy syndrome. Limitations: The limitations of this study include paucity of evidence. Conclusion: The evidence based on this systematic review for thoracic epidural injection in treating chronic thoracic pain is considered fair and limited for post thoracotomy pain. Key words: Spinal pain, chronic mid back pain, chronic upper back pain, post-thoracotomy pain, thoracic epidural injection, radiculopathy, herniation, steroids, local anesthetic, epidural steroid

Thoracic Radicular Pain

2018 ◽  
pp. 237-242
Author(s):  
Victor Foorsov ◽  
Sarah M. Pastoriza
Keyword(s):  
Surgical Intervention ◽  
Clinical Symptoms ◽  
Radicular Pain ◽  
Vertebral Compression Fractures ◽  
Thoracic Pain ◽  
Thoracic Epidural ◽  
Epidural Injections ◽  
Treatment And Prevention ◽  
General Exercise ◽  
Pain Symptoms

Thoracic radiculopathy presents an uncommon spinal disorder that can often be overlooked because numerous structures surround the thoracic spine. Radiculopathy typically originates from mechanical nerve root compression due to degenerative spine changes such as disc herniation, spondylosis, or osteoporosis and its associated vertebral compression fractures. The presentation of radicular pain in the thoracic region is more common in the upper thoracic and, with lateral disk herniations, often associated with some amount of axial pain. Clinical symptoms are leg weakness, numbness and tingling across the chest or abdomen or shoulders, spasticity, and bowel or bladder dysfunction. The vast majority of patients with thoracic pain return to their previous functional level without surgical intervention. Strengthening, postural optimization, and general exercise and mobility comprise the cornerstone of all treatment and prevention of thoracic radicular pain. Medication may include a variety of choices, ranging from NSAIDs to anticonvulsants. Medications to address specific health issues leading to thoracic radiculopathy (diabetes mellitus and osteoporosis) may be of additional benefit. Thoracic epidural injections or paravertebral blocks with corticosteroids and local anesthetics may be a treatment consideration. Surgical intervention is reserved for patients in whom conservative management has failed and who have persistent pain symptoms. Myelopathy is an indication for surgical intervention. Spinal cord stimulation may be effective to address chronic radiculopathy in selected patients.

scholarly journals A REPORT OF ACUTE THORACIC EPIDURAL HEMATOMA AFTER INTERLAMINAR EPIDURAL INJECTION

2017 ◽  
pp. 33-38
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Case Report ◽  
Antithrombotic Therapy ◽  
Epidural Hematoma ◽  
Low Dose ◽  
Epidural Injection ◽  
Potential Effect ◽  
Surgical Decompression ◽  
Thoracic Epidural ◽  
Epidural Injections ◽  
Increased Risk

While interlaminar and caudal epidural injections are frequently performed for chronic spinal pain, thoracic epidural injections are uncommon; constituting less than 5%. As a result, reports of complications related to thoracic epidural injections are rare including epidural hematoma leading to surgical decompression. Multiple strategies to prevent epidural hematoma in any region of the spine exist and include cessation of therapy with antithrombotics and anticoagulants, fi sh oil, and other drugs with a potential effect on coagulation. Thus far, multiple guidelines have recommended continuation of nonsteroidal antiinfl ammatory drugs (NSAIDs) and low dose aspirin. Some guidelines also have recommended continuation of antithrombotic therapy because of the increased risk of thromboembolic phenomenon in these patients. We report a case of thoracic epidural hematoma requiring surgical decompression without resultant residual dysfunction. It involves a thoracic epidural injection following which the patient developed left leg paresis over a 2-hour postinjection period. She was receiving low dose (81 mg) aspirin. She underwent surgical decompression with rapid recovery. This case report of acute thoracic epidural hematoma following interlaminar epidural steroid injection in a patient without antithrombotic therapy is rare, that could have been fatal without appropriate diagnosis and intervention. This case report shows that various commonly considered factors and precautions undertaken to avoid epidural hematoma formation are ineffective. This case report also illustrates the importance of prompt diagnosis, and emphasizes increasing levels of axial pain as most signifi cant features for the diagnosis. Key words: Interventional techniques, thoracic epidural injections, thoracic epidural hematoma, bleeding disorders, aspirin, antithrombotic agents, anticoagulants, nonsteroidal antiinfl ammatory drugs

scholarly journals Thoracic Interlaminar Epidural Injections in Managing Chronic Thoracic Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E327-E338 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Back Pain ◽  
Local Anesthetic ◽  
Controlled Trial ◽  
Low Back ◽  
Thoracic Pain ◽  
Double Blind ◽  
Thoracic Epidural ◽  
Epidural Injections ◽  
Group I ◽  
Group Ii

Background: Reports of prevalence of spinal pain indicate the prevalence of thoracic pain in approximately 13% of the general population compared to 32% of the population with neck pain and 43% of the population with low back pain during the past year. Even though, thoracic pain is less common than neck or low back pain, the degree of disability resulting from thoracic pain disorders seems to be similar to other painful conditions. Interventions in managing chronic thoracic pain are also less frequent, leading to the paucity of literature about various interventions in managing chronic thoracic pain. Thoracic intervertebral discs and thoracic facet joints have been shown to be pain generators, even though thoracic radicular pain is very infrequent. Thoracic epidural injections are one of the commonly performed procedures in managing thoracic pain. The efficacy of thoracic epidural injections has not been well studied. Study Design: A randomized, double-blind, active controlled trial. Setting: Private interventional pain management practice and specialty referral center in the United States. Objective: The primary objective was to assess the effectiveness of thoracic interlaminar epidural injections in providing effective pain relief and improving function in patients with chronic mid and/ or upper back pain. Methods: One hundred and ten patients were randomly assigned into 2 groups with 55 patients in each group receiving either local anesthetic alone (Group I) or local anesthetic with steroids (Group II). Randomization was performed by computer-generated random allocation sequence by simple randomization. Outcomes Assessment: Outcomes were assessed utilizing Numeric Rating Scale (NRS), the Oswestry Disability Index (ODI) 2.0, employment status, and opioid intake. The patients experiencing greater than 3 weeks of significant improvement with the first 2 procedures were considered as successful. Others were considered as failed participants. Significant improvement was defined as a decrease of greater than 50% NRS scores and ODI scores with measurements performed at baseline, 3, 6, 12, 18, and 24 months post treatment. Results: Significant improvement was seen in 71% in Group I and 80% in Group II at the end of 2 years with all participants; however, improvement was seen in 80% and 86% when only successful patients were considered. Therapeutic procedural characteristics showed 5 to 6 procedures per 2 years with total average relief of 80 weeks in Group I and 78 weeks in Group II in the successful patient category; whereas, it was 71 and 72 weeks when all patients were considered. Limitations: Limitations of this assessment include lack of a placebo group.Conclusions: Based on the results of this trial, it is concluded that chronic thoracic pain of non-facet joint origin may be managed conservatively with thoracic interlaminar epidural injections with or without steroids. Key words: Chronic thoracic pain, chest wall pain, disc herniation, discogenic pain, radiculitis, thoracic interlaminar epidural injections, steroids, local anesthetic

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