P56. Outcomes of thoracic transforaminal epidural steroid injections: A case series

Abstract

<h3>BACKGROUND CONTEXT</h3> There is extremely sparse literature reporting on the outcomes of thoracic transforaminal epidural steroid injections, including the efficacy and safety of this approach. There have been a few studies looking at the outcomes of interlaminar thoracic epidural steroid injections, with Benyamin et al concluding that the evidence behind thoracic epidural steroid injections is considered fair. <h3>PURPOSE</h3> To investigate the outcomes of patients with thoracic radicular pain who underwent thoracic transforaminal epidural steroid injections. <h3>STUDY DESIGN/SETTING</h3> Retrospective case series study from January, 2016 to December, 2019 at a single academic medical center. <h3>PATIENT SAMPLE</h3> Patients who underwent thoracic transforaminal epidural steroid injections for thoracic radicular pain during the months selected above. <h3>OUTCOME MEASURES</h3> Primary outcome: pain score using a numeric rating score. Secondary outcomes: need for repeat injection, progression to surgery, complications of the injections <h3>METHODS</h3> Retrospective chart review of patients who underwent thoracic transforaminal epidural steroid injection. <h3>RESULTS</h3> Six patients (mean age = 60.3 years with a SD = 11.8 years) underwent thoracic transforaminal epidural steroid injection for the treatment of thoracic radicular pain that was non-responsive to conservative care. Three out of 6 patients had pain duration of 6 months or less, and 5/6 patients had pain duration of 16 months or less. All injections were performed in accordance with Spine Intervention Society technique guidelines. Dexamethasone was used for all injections. The patient's thoracic MRIs underwent independent review by two physicians; it was determined that 3 patients had thoracic disc herniation, 2 with spondylitic stenosis, and 1 MRI was no longer available for review. Five of the 6 patients underwent a single level unilateral injection, with the other undergoing a two-level unilateral injection. Median pain score using a numeric rating scale prior to injection was 5 (IQR = 4-7.5). At follow-up (mean = 29.5 days), median pain score was 3 (IQR = 0.25-5.75), three patients received greater than 75% pain reduction, and 2 patients had complete resolution of their pain. Five patients underwent repeat injection with a mean time to repeat injection of 77 days (SD = 107 days). None of the patients progressed to surgery. One symptomatic but transient vasovagal reaction occurred, with no other complications noted. <h3>CONCLUSIONS</h3> Although only a case series, this is significant in reporting outcomes for the transforaminal approach in the thoracic spine. Of note, 50% of our patients experienced greater than 75% relief, which appears promising despite the limited ‘n'. Thoracic transforaminal epidural steroid injection is known to have an inherit risk of pneumothorax; however, of the 11 injections performed, this was not an observed complication. Further research is needed, including multisite cohort studies to obtain a larger ‘n', as well as prospective studies. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.