Thoracic transforaminal epidural steroid injection for management of thoracic spine pain: A multicenter cross-sectional study of short-term outcomes

Background Thoracic transforaminal epidural steroid injections (TFESIs) are procedures performed for the treatment of thoracic spine pain (TSP). The literature on these interventions is sparse. Purpose To report outcomes of thoracic TFESIs for TSP indications. Study design Multicenter, retrospective, cross-sectional cohort study. Patient sample Consecutive patients receiving thoracic TFESIs at three academic spine centers. Outcome measures The primary outcome was the proportion of patients reporting at least 50% improvement in NRS pain score at short-term follow-up (>1 week, <3 months post-injection). Methods A chart review was performed of consecutive patients who underwent a thoracic TFESI over a 4- to 10-year time period at three academic spine centers and had reported an NRS pain score at short-term follow-up. Results Overall, 19/64 patients (30% [95% CI 20–42%]) experienced ≥50% relief following the injection at a median 22 days follow-up. 42% [95% CI 31–54%] experienced at least a 2-point improvement in NRS score. There was a slight improvement in median NRS scores from pre-to post-procedure of −1 (IQR -3, 0), from 6/10 to 5/10 (p ​< ​0.001). The success rate (≥50% pain relief) was 36% [95%CI 22–52%] in those with a disc herniation as compared to 21% [95%CI 10–40%]) in those with degenerative stenosis; however, the difference did not reach statistical significance. There was a trend towards a greater success rate in those who were employed vs. unemployed (43% [95% CI 27–61%] vs. 19% [95% CI 9–36%]). Conclusions This is the largest series reporting outcomes from thoracic TFESI to date. Overall, the observed success rate was low compared to known success rates associated with TFESI for the treatment of pain at cervical and lumbar spinal regions.