Thoracic Epidural Injection
Pain Treatment Procedure
Thoracic Epidural Injection
A thoracic epidural steroid injection (TESI) is a minimally invasive, non-surgical procedure that targets pain and inflammation in the thoracic spine (the part of your spine that runs between your neck and lower back). A corticosteroid is injected into the epidural space around your spinal cord to calm painful, inflamed nerves.
Thoracic ESIs treat persistent upper or mid-back pain caused by herniated (slipped) discs, pinched nerves or spinal stenosis (spinal canal narrowing). They are also used to diagnose the nerves responsible for your pain.
What Is a Thoracic Epidural Steroid Injection?
A thoracic epidural injection is a diagnostic or therapeutic tool used in the management of pain in the upper and middle back. The shot delivers a corticosteroid (anti-inflammatory medication) directly into the epidural space of the thoracic region, typically between your shoulder blades. This area can become irritated due to inflamed or compressed nerves, often from issues like herniated discs or spinal arthritis.[1] By calming the inflammation around the affected nerves, a thoracic ESI or TESI can help reduce pain, numbness, and tingling in the upper or mid-back region.[2]
This procedure is beneficial when thoracic pain isn’t responding well to oral medications, physical therapy, or rest.
How Does a Thoracic ESI Work?
Thoracic ESIs are usually performed using the interlaminar approach, where the needle is guided between two vertebrae (laminae) into the epidural space.[3] This is different from the transforaminal approach, which delivers medication through a nerve opening (foramen) and is more targeted. Interlaminar injections tend to bathe a broader area of the spine.
According to the experts at Johns Hopkins Medicine, here’s what to expect during your thoracic epidural procedure:
- You’ll lie face down on an X-ray table.
- The skin is cleaned and numbed.
- Using live imaging (fluoroscopy), the physician carefully guides a needle into the epidural space in your thoracic spine.
- A contrast dye confirms placement, then a steroid and anesthetic mixture is injected.
- The entire process usually takes about 15–30 minutes, and you’ll be monitored for a short time afterward.
Most patients can go home the same day. Some feel relief within a few days, while others may need a series of injections spaced weeks apart for the full effect.[4]
Conditions Treated with Thoracic Interlaminar Injections
Thoracic ESIs can help relieve pain caused by:
- Thoracic spinal nerve irritation and inflammation [1]
- Thoracic disc herniation [2]
- Degenerative disc disease [1]
- Spinal stenosis [2]
- Compression fractures [1]
- Spinal nerve injury [1]
- Post-surgical pain syndromes [5]
- Thoracic radiculopathy (pinched nerve) [1]
- Spondylolysis and Spondylolisthesis [1]
- Shingles pain or postherpetic neuralgia [5]
- Spinal bone spurs
Benefits of Thoracic Epidural Steroid Injections
When performed as part of a broader pain management plan, thoracic ESIs can offer several benefits:
- Targeted Pain Relief: Medication is delivered directly to inflamed or irritated nerves in the upper and mid-back for more effective results.
- Minimally Invasive: A non-surgical option with a short recovery time and minimal risks.
- Repeatable: Relief may last several weeks to several months, and injections can be repeated several times a year.
- Reduced Inflammation: The corticosteroid decreases swelling and pain around the thoracic spinal nerves.[1]
- Better Quality of Life: Reduced pain and inflammation help maintain comfort and mobility while improving sleep quality.
- Surgery Alternative: May help delay or prevent the need for more invasive procedures like a laminectomy or spinal fusion.
- Fewer Side Effects: Steroids delivered directly to the affected nerves pose less risk than oral steroids or pain relievers.
These injections are typically used in combination with physical therapy, medications, and lifestyle changes for longer-lasting relief.
Thoracic ESI Specialists and Pain Management Clinics
You may be a good candidate for a thoracic epidural injection if your upper or mid-back pain has become chronic and isn’t getting better with conservative treatments like rest, physical therapy, or medication. It’s beneficial if imaging tests show signs of nerve compression or inflammation in the thoracic spine. This procedure is also a great option if you’re not ready for surgery or hoping to avoid it altogether.
Your pain specialist will take a whole-body, multidisciplinary approach to maximize your results. Your treatment plan may include guided exercise, cognitive support, and other targeted interventions tailored to your unique health needs and goals.[5]
Living with constant upper back pain can make even simple tasks feel overwhelming. But you don’t have to manage it alone. Schedule a pain management consultation to see if a TESI is the right approach for your chronic pain. A targeted steroid injection might be the relief you’ve been waiting for, so you can get back to doing the things that matter most.
Resources:
- Patel K, Chopra P, Martinez S, et al. Epidural Steroid Injections. [Updated 2024 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Accessed July 31, 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470189
- Thoracic Epidural Injection. Johns Hopkins Medicine [Internet]. Accessed July 31, 2025. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/thoracic-epidural-injection
- Epidural Steroid Injection (ESI). Cleveland Clinic [Internet]. Accessed July 31, 2025. Available from: https://my.clevelandclinic.org/health/treatments/22301-epidural-steroid-injection-esi
- Funiciello M. Epidural Steroid Injections. Spine-health [Internet]. Updated June 06, 2019. Accessed July 31, 2025. Available from: https://www.spine-health.com/treatment/injections/epidural-steroid-injections
- LCD – Epidural Steroid Injections for Pain Management (L36920). Centers for Medicare & Medicaid Services (CMS) [Internet]. Accessed July 31, 2025. Available from: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=36920