Section 1 of 6
Start with the patient
Match the level and side to the symptoms and imaging.
Risks and benefits
Intended benefit
The goal is relief of level-specific thoracic radicular pain and better function. Controlled trial evidence for the thoracic transforaminal route is limited; expectations rest largely on lumbar and cervical data and on the thoracic interlaminar trial.
Risks and tradeoffs
Beyond the risks of any epidural injection, the lung lies beside the needle path (pneumothorax), and the radiculomedullary arteries that supply the cord enter mostly at T8–L1, so paraplegia after injection, though rare, has been reported. The multisociety safeguards require nonparticulate steroid for cervical and advise it first for lumbar transforaminal injection, with real-time contrast; they give no thoracic rule, so nonparticulate steroid is the conservative extrapolation.
Make the decision together
Discuss the interlaminar alternative, rehabilitation and medication. Set a functional goal and a reassessment plan, and agree what new symptoms after the procedure need urgent attention.