Thoracic Transforaminal Epidural Access
Background: Thoracic transforaminal epidural steroid injections (Thoracic TF-ESIs) were developed as an equivalent to lumbar level techniques. They have been received with skepticism and are perceived as technically demanding with an increased risk of complications.
Indications: Thoracic TF-ESIs may be a useful alternative in the treatment of intractable thoracic neuropathic pain, such as radicular pain from disk herniation, posthoracotomy, or postherpetic neuralgia. The current chapter is limited to two advanced access techniques and is not intended to discuss the efficacy or safety of Thoracic TF-ESIs.
Technique: The most studied and popular technique to date is with an oblique approach. The oblique approach is based on an anatomical “box” described in the chapter.
Pitfalls: The trajectory near the pleura and lungs is specific to the Thoracic TF-ESI technique.
KeywordsPain Thoracic radiculopathy Thoracic transforaminal Thoracic spinal nerve Epidural steroid injection
- 1.Bogduk N, editor. Practice guidelines for spinal diagnostic and treatment procedures. 2nd ed; International Spine Intervention Society, San Francisco, 2013.Google Scholar
- 3.Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques of chronic spinal pain: part II: guidance and recommendations. Pain Physician. 2013;16:S49–283.Google Scholar
- 4.Manchikanti L, Cash KA, McManus CD, et al. Thoracic interlaminar epidural injections in managing chronic thoracic pain: a randomized, double-blind, controlled trial with a 2-year follow-up. Pain Physician. 2014;17:E327–38.Google Scholar