Section 1 of 6
Define the treatment question
Link the thoracic symptoms, imaging and intended benefit.
Risks and benefits
Intended benefit
The goal is relief of chronic thoracic radicular or axial pain and better function. One randomized trial (110 selected patients with chronic thoracic pain not of facet origin; local anesthetic with or without steroid, no placebo arm) reported 50 % or greater improvement in 71–80 % at two years, after about 5–6 injections; adding steroid gave no significant overall advantage. A systematic review rates the evidence as fair.
Risks and tradeoffs
In one fluoroscopic series of 39 thoracic interlaminar injections, minor effects occurred in about one in five (site pain, flushing, headache, insomnia, fever), with no major complication. Dural puncture, cord injury, bleeding, infection and medication reactions are rarer and more serious; the cord lies just beneath the dura here.
Make the decision together
Compare rehabilitation and medication, set a functional goal and plan reassessment. Explain that the trial had no placebo arm and that thoracic evidence is thinner than lumbar.