Spine Intervention Society Research Articles

Genicular nerve radiofrequency ablation practice patterns: A survey study of the International Pain and Spine Interventional Society

IntroductionChronic knee pain often results from degenerative conditions such as knee osteoarthritis (OA) and can worsen after surgical interventions like total knee arthroplasty (TKA). Knee OA affects approximately 86 million individuals globally, leading to decreased function, mobility limitations, and disability. While TKA is a common surgical treatment for refractory knee OA, though up to 20 % of patients experience chronic post-operative knee pain worse than their pre-operative pain. Genicular nerve radiofrequency ablation (GnRFA) has emerged as a promising intervention for knee OA pain unresponsive to conservative management and for chronic post-TKA pain. GnRFA is an evidence-based technique supported by multiple prospective cohort studies and randomized controlled trials (RCTs). However, practice patterns and GnRFA techniques vary, and no peer-reviewed publication has yet quantified these variations in real-world clinical practice. ObjectiveThis study aims to understand the practice patterns of interventional pain physicians regarding patient selection, use of prognostic blocks, imaging, nerve targets, GnRFA types, and GnRFA techniques in treating knee pain secondary to OA or persistent post-TKA pain. MethodsAn anonymous 29-question survey was distributed via electronic mail to members of the International Pain and Spine Intervention Society (IPSIS) from January 16, 2024, to February 29, 2024. The survey assessed practice patterns related to patient selection, prognostic block use, and GnRFA techniques. Data were collected and stored using REDCap software, with descriptive statistics calculated. ResultsA total of 150 completed surveys were analyzed, representing a completion rate of 2.0 % of surveys sent, 3.5 % of emails opened, and 56.8 % of those who clicked on the survey link. Respondents generally use common selection protocols regarding OA grade (Kelgren-Lawrence 3 and 4), duration of failed conservative care (3–6 months), a single anesthetic block paradigm, and use of fluoroscopic guidance for the GnRFA procedure. More variability was reported between respondents regarding the volume of anesthetic used during prognostic blocks, the threshold to consider a prognostic block “positive,” the technology used, and nerves targeted during the GnRFA procedure. ConclusionThe study provides valuable insights into the current practice patterns of GnRFA among interventional pain physicians. While there is consensus on some aspects of patient selection and procedural techniques, significant variability exists in prognostic block protocols and nerve targets for GnRFA. These findings highlight the need for further research to explore the long-term efficacy and safety of GnRFA and to standardize techniques and protocols across different practice settings, ultimately improving patient outcomes and quality of life. The low response rate may limit generalizability, and the survey did not include data on active tip sizes used for ablation or whether other procedures should be exhausted before resorting to GnRFA. Additionally, a survey to IPSIS membership only may not fully represent a diverse cohort of pain management specialists, potentially introducing sampling bias. Future studies should include members from a broader range of professional organizations to enhance representativeness.

Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society

BackgroundThere is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic–pituitary axis. Published studies note that doses...

True lateral imaging during lumbar medial branch radiofrequency neurotomy: Interobserver reliability

BackgroundTrue lateral imaging (TLI), obtained by superimposing bilateral lumbar spine structures and aligning superior endplate cortical bone, requires deliberate rotational adjustments of the laterally positioned fluoroscope in both the axial and longitudinal planes. True lateral segmental imaging is necessary to depict true and accurate radiofrequency (RF) cannula positioning relative to bony anatomy during lumbar medial branch radiofrequency neurotomy (LMBRFN). ObjectiveTo determine the interobserver reliability of TLI during LMBRFN. MethodsThis was a retrospective review of a prospectively generated collection of lateral fluoroscopic images to determine the interobserver reliability of TLI during LMBRFN. Lateral fluoroscopic images were prospectively collected from 34 consecutive L4-5 and L5-S1 LMBRFN procedures during routine clinical practice. Employing International Pain and Spine Intervention Society (IPSIS) LMBRFN and TLI techniques, an RF cannula was positioned parallel to the L3 and L4 medial branches and the L5 dorsal rami. During the normal course of TLI, untrue and final true lateral segmental images were obtained and saved. An original data set of 100 pairs of true and untrue lateral images was reviewed to verify true laterality using established criteria; disagreement was resolved by consensus or discarding ambiguous cases. To measure interobserver reliability (Cohen's Kappa), two blinded expert reviewers independently reviewed the image set, identifying the true lateral image and the plane requiring correction. ResultsThe observers agreed upon 98/98 true lateral RF-segment images (Kappa score 1.0 [1.00,1.00]). The observers agreed upon 86/98 maneuvers to correct the untrue RF-segment image. The Kappa score for determining the most appropriate corrective maneuver was 0.76 (0.63,0.89), showing substantial interobserver agreement. ConclusionsThe true lateral image of the targeted RF segment during LMBRFN was reliably determined with perfect interobserver agreement. Interobserver agreement was substantial regarding the maneuver to achieve TLI.

Interventional pain physician beliefs on climate change: A Spine Intervention Society (SIS) survey

Summary of background dataAlthough evaluated within other specialties, physicians’ beliefs towards climate change and human health have not been described within Interventional Pain Medicine (IPM). Understanding belief systems is essential for developing solutions to build sustainable practices. ObjectivesAssess beliefs toward climate change within the field of IPM. MethodsSpine Intervention Society (SIS) members were invited to participate in an anonymous RedCap survey by email, social media, and advertisement at the 2022 SIS Annual Meeting. Descriptive statistics were calculated, and associations were estimated using Chi-Square (significance: p < 0.05). ResultsOne hundred and seventy-five participants responded to the survey. Participants most often identified as white (66 %; 95 % CI 57–73 %), male (78 %; 95 % CI 71–84 %), and from the United States (US) (76 %; CI 95 % 58–72 %), with 87 % (n = 123/141; 95 % CI 82–93 %) agreeing that climate change is happening (agree or strongly agree). While 78 % (95 % CI 80–92 %) agree that climate change and sustainability are important to them, only 47 % (95 % CI 34–51 %) agree that these are important to their patients. Those beliefs did not differ by age or geographical area (p > 0.05). However, physicians in non-leadership positions are more likely to disagree or strongly disagree that climate change is important to them (χ2(2) = 15.98; p < 0.05), to their patients (χ2(2) = 17.21; p < 0.05), or that societies should advocate for climate policies (χ2(2) = 9.19; p < 0.05). Non-US physicians were more likely to believe that physicians have responsibilities to bring awareness to the health effects of climate change (χ2(2) = 6.58; p < 0.05) and to agree that climate change is important to their patients (χ2(2) = 10.50; p < 0.05). Discussion/conclusionUnderstanding specialty-specific physician views on climate change is essential for developing solutions to reduce the carbon footprint of medical practice and improve sustainability. The majority of SIS members believe that climate change is happening. Non-US physicians and physician-leaders are more likely to believe that climate change impacts their patients and that societies should advocate for climate policies.

Is routine intravenous access commonly established before interventional pain procedures? Results of a spine intervention society practice pattern survey

Summary of background dataEstablishing routine intravenous (IV) access prior to interventional pain procedures performed without sedation is controversial. Anecdotally, practices very in terms of their use of routine IV access. ObjectivesTo determine the frequency with which routine IV access is obtained for various common interventional pain procedures among interventional pain providers. MethodsAn anonymous survey was distributed to physician members of the Spine Intervention Society (SIS) on 08/13/2020, and remained open until 10/13/2020. Respondents provided information regarding demographics and current practice patterns. Results141 SIS members completed the survey. A bimodal distribution was noted for most procedures, with most providers obtaining routine IV access either 0% of the time or 81–100% of the time. Routine IV access was used more frequently when performing cervical spine procedures, splanchnic or hypogastric plexus blocks, lumbar sympathetic blocks, and spinal cord stimulator trials. Excluding cases where IV's were used for sedation, the only procedures which providers obtained routine IV access more often than not were spinal cord stimulator trials, splanchnic/celiac plexus blocks, and hypogastric plexus blocks. Over half (52.5%) of respondents reported using an IV for an emergent situation in their career. While most providers would not modify their IV usage based on practice location, those that would were significantly more likely to decrease IV use if working in clinic-based procedures suites (n ​= ​25) compared to hospital-based surgical centers (n ​= ​2) or ambulatory surgical centers (n ​= ​9, p ​< ​0.001). Discussions/conclusionsThere remains wide variation among practitioners in establishing routine intravenous access prior to interventional procedures. Most providers surveyed do not routinely establish IV access for the majority of interventional pain procedures. Routine IV access is more commonly obtained for cervical spine procedures than other spinal regions. Overall, complications precipitating the need for IV use are rare in interventional spine but likely to happen over the course of a career.

Clinical practice patterns of opioid prescribing by physicians -performing percutaneous spinal cord stimulation trials and implants.

Spinal cord stimulation (SCS) is an effective therapy for neuropathic pain. Outcomes of SCS may be influenced by peri-implant opioid management; however, to date, standard practices of opioid management in this scenario remain undefined and unreported. A survey inquiring SCS management practices in the peri-implant period was sent to the members of the Spine Intervention Society and the American Society of Regional Anesthesia. The results of three questions pertaining to peri-implant opioid management are presented here. For each of the three questions examined, there were between 181 and 195 responses. Among respondents, 40 percent encouraged reduction of opioids prior to SCS trial, and 17 percent mandated reduction. After a SCS trial, 87 percent of respondents did not provide any additional opioids for periprocedure pain. After implant, the majority of respondents provided 1-7 days of opioids for post-operative pain. Based upon survey results and current literature, it is advisable to recommend or attempt opioid reduction before SCS and to not provide additional opioid for post-operative pain after trial lead insertion. Routine prescribing for the pain of the SCS implant beyond 7 days is not favored.

Best practices for interventional pain procedures in the setting of a local anesthetic shortage: A practice advisory from the Spine Intervention Society

Representatives from the Spine Intervention Society (SIS) Standards Division and Evidence Analysis Committee have developed the following best practice recommendations for the performance of interventional pain procedures in the setting of a local anesthetic shortage. The practice advisory has been endorsed by SIS, the American Academy of Pain Medicine, the American College of Radiology, the American Society of Neuroradiology, the American Society of Spine Radiology, the North American Neuromodulation Society, the North American Spine Society, and the Society of Interventional Radiology, who support the following best practice recommendations and statements for the performance of intra-articular, extra-articular, paraspinal, and epidural injections in the setting of a local anesthetic shortage.1.Use of preservative-containing local anesthetics is discouraged in the performance of neuraxial procedures where the injectate may enter the epidural (or intrathecal) spaces.2.When performing procedures with risk of arterial injection, ropivacaine should not be mixed with dexamethasone and injected due to the risk of crystallization and embolization.3.Physicians should not withdraw directly from vials of local anesthetic for multiple patients due to infection risk as per Centers for Disease Control and Prevention (CDC) and Joint Commission guidelines [1].4.Only pharmacists may repackage local anesthetic vials for multiple patients. This must be performed under strict, sterile conditions and only in times of critical need. In such situations, physicians must adhere to the beyond-use-date and storage conditions on the repackaged label [2,3].5.Joint, tendon, bursa, and/or ligament injections may be performed with local anesthetic with or without preservative.6.Interventional pain physicians should weigh the relative chondrotoxicity risks associated with each anesthetic when performing joint injections.7.Topical anesthetics, infiltration with diphenhydramine, and nonpharmacologic therapies (i.e., cognitive behavioral therapy, guided imagery, virtual reality, mechanodesensitization) may be used as alternatives to skin infiltration of local anesthetic for reducing procedural pain.8.Use of small-gauge needles (25 gauge or thinner) mitigates the need for local anesthetic prior to needle insertion.9.For local anesthetic infiltration prior to insertion of large bore needles or incision, 0.5% lidocaine may be as effective as 1%, and for that reason current supplies of lidocaine can be stretched by dilution with normal saline.10.If using an ester local anesthetic due to an amide local anesthetic shortage, interventional pain physicians should be aware (as always) of the potential for an allergic reaction and should be able to respond accordingly.11.Local anesthetic systemic toxicity (LAST) differs between the varying local anesthetics, and interventional pain physicians should be well acquainted with these differences when switching between local anesthetics.Physicians should carefully weigh the risks and benefits of performing procedures without local anesthetic or using an alternative agent in the context of each unique patient's situation and should involve patients in shared decision making before proceeding.Procedures should be performed following Spine Intervention Society Guidelines [4]. The physician should confirm placement of the needle in at least two imaging planes. Please refer to the SIS Practice Guidelines for the full details and standards related to each unique procedure [4].

Waste Management and Educational Interventions for Sustainability: A Spine Intervention Society (SIS) Physician Survey

Waste Management and Educational Interventions for Sustainability: A Spine Intervention Society (SIS) Physician Survey

Climate Change, Sustainability, and Human Health: A Spine Intervention Society (SIS) Physician Survey

Climate Change, Sustainability, and Human Health: A Spine Intervention Society (SIS) Physician Survey

Predictors of Compensation for U.S. Interventional Pain Physicians: Survey Results from the Spine Intervention Society

Predictors of Compensation for U.S. Interventional Pain Physicians: Survey Results from the Spine Intervention Society

Predictors of Job Stability After Training: Survey Results from the Spine Intervention Society

Predictors of Job Stability After Training: Survey Results from the Spine Intervention Society

Current trends in the technical performance of lumbar zygapophyseal joint interventions

ObjectiveTo survey how interventional pain physicians are currently performing lumbar facet interventions, with an emphasis on fellowship training. DesignSurvey Study. MethodsAn online electronic survey disseminated via Research Electronic Data Capture (REDCap) software to current and expired attending physician members of the Spine Intervention Society (SIS). Responses were stratified by fellowship training type: ACGME Pain Medicine (APM), ACGME Sports Medicine (ASM), Interventional Spine and Musculoskeletal Medicine (ISMM), or None. ResultsAs a whole, a majority of respondents indicated on independent questions they require 2 diagnostic medial branch blocks (MBBs) performed with 0.5 ​cc or less of anesthetic to result in at least 75% pain relief before proceeding with a radiofrequency neurotomy (RFN), performed via parallel approach with 18g or larger needle and 10 ​mm active tip and a lesion of at least 80–85° C and 90–119 ​s of duration. Statistically significant differences as stratified by APM vs ISMM fellowship training included: the use of corticosteroids at the time of RFN (43/79 (54.4%) vs 16/63 (25.4%), typically treating 3 segments or more 22/79 (27.8%) vs 7/73 (9.6%), and MBB volume injectate of ≥ 1 ​cc 22/79 (27.8%) vs 7/63 (11.1%) respectively. ConclusionsThere is largely agreement upon the technical performance of lumbar facet interventions by members of SIS. Physicians who completed an APM fellowship were more likely to report using corticosteroids at the time of RFN, using higher anesthetic volumes and treating 3 or more spinal segments.

A Survey on the Choice of Spinal Cord Stimulation Parameters and Implantable Pulse Generators and on Reasons for Explantation.

Spinal Cord Stimulation (SCS) is a vital treatment for chronic intractable pain. In the last few years, the field has undergone dramatic changes in new waveform and frequency introduction as well as device miniaturization. It is important to understand contemporary practice patterns regarding these parameters. We surveyed the active membership of Spine Intervention Society (SIS), and American Society of Regional Anesthesia (ASRA) on their practices regarding various aspects of Spinal Cord Stimulation therapy. Here we report on SCS waveform usage, battery types, and causes of explant in this cohort of providers. There was similar degree of usage of tonic, burst, and 10 kHz usage at 71.5%, 74.1% and 61.7% respectively. Dorsal root ganglion stimulation was used by 32.6% and other modes of stimulation by 13.5%. Rechargeable systems were often or always used by 67.2% whereas 10% never used a rechargeable system. Most common cause of explant was loss of effectiveness, reported by 53.7%. There has been significant adoption of new waveforms in daily practice of spinal cord stimulation therapy and there is robust mixed usage of new waveforms and frequencies. Rechargeable systems are the most commonly used but primary cell is also used in significant numbers. Loss of efficacy remains the most common cause of explant for the majority of practitioners. This survey establishes practice patterns of SCS usage regarding these important variables against which future changes can be gauged.

Dural Puncture During Spinal Cord Stimulator Lead Insertion: Analysis of Practice Patterns.

BackgroundSpinal cord stimulation (SCS) is an important modality for intractable pain not amenable to less conservative measures. During percutaneous SCS lead insertion, a critical step is safe access to the epidural space, which can be complicated by a dural puncture.ObjectivesIn this review, we present and analyze the practices patterns in the event of a dural puncture during a SCS trial or implantation.MethodsWe conducted a survey of the practice patterns regarding spinal cord stimulation therapy. The survey was administered to members of the Spine Intervention Society and American Society of Regional Anesthesia specifically inquiring decision making in case of inadvertent dural puncture during spinal cord stimulator lead insertion.ResultsA maximum of 193 responded to a question regarding dural punctures while performing a SCS trial and 180 responded to a question regarding dural punctures while performing a SCS implantation. If performing a SCS trial and a dural puncture occurs, a majority of physicians chose to continue the procedure at a different level (56.99%), followed by abandoning the procedure (27.98%), continuing at the same level (10.36%), or choosing another option (4.66%). Similarly, if performing a permanent implantation and a dural puncture occurs, most physicians chose to continue the procedure at a different level (61.67%), followed by abandoning the procedure (21.67%), continuing at the same level (10.56%), or choosing another option (6.11%).ConclusionsWhereas the goals of the procedure would support abandoning the trial but continuing with the permanent in case of inadvertent dural puncture, we found that decision choices were minimally influenced by whether the dural puncture occurred during the trial or the permanent implant. The majority chose to continue with the procedure at a different level while close to a quarter chose to abandon the procedure. This article sets a time stamp in practice patterns from March 20, 2020 to June 26, 2020. These results are based on contemporary SCS practices as demonstrated by this cohort, rendering the options of abandoning or continuing after dural puncture as reasonable methods. Though more data is needed to provide a consensus, providers can now see how others manage dural punctures during SCS procedures.

Virtual reality for procedural education: Lumbar medial branch radiofrequency neurotomy

Virtual reality (VR) simulation is an emerging tool in medical education. Simulation conducted in VR can reproduce procedural scenarios and allow for immersive interaction with anatomic models. This has the potential to improve understanding of anatomy and concepts relevant to interventional procedures.Here, we present a “proof-of-concept” modeling of lumbar thermal radiofrequency neurotomy through cost-effective, commercially available VR hardware and software. With this technology, we can demonstrate key fluoroscopic views and needle trajectories based on specific recommendations from Spine Intervention Society guidelines. Furthermore, the learner can manipulate the model in multiple 3-dimensional axes to visualize anatomy relevant to key fluoroscopic views. Finally, the content can be exported by recording a live casting stream, thus offering an approach for future content creation and collaboration.VR technology is an emerging educational modality that offers immersive and interactive features that may offer advantages to traditional visual teaching modalities.

Contralateral and Lateral Views: Analysis of the Technical Aspects of Spinal Cord Stimulator Lead Insertion.

BackgroundSpinal cord stimulation (SCS) is an established treatment modality for neuropathic pain. The critical part of this technique is safe access to the epidural space for lead placement. There have been innovations in radiological views, improving access to the epidural space.ObjectivesThis study analyzes the adoption of these technical advantages in daily practiceMethodsWe conducted a survey of members in the Spine Intervention Society and American Society of Regional Anesthesia in regard to the practice patterns in SCS therapy. Here we present our findings regarding the use of contralateral oblique (CLO) and lateral views as well direct upper thoracic or cervicothoracic access for SCS lead insertionResultsA total of 195 unique responses were received between March 20, 2020 and June 26, 2020. Forty-five percent of respondents “always used” the lateral view technique while 15% “always used” CLO view for SCS lead insertion. Overall, sixty-five percent of respondents used the CLO view with varying frequency. Cervical and upper thoracic approach for cervical SCS lead placement is always or often used by 66.8% of the respondents.ConclusionsA depth view (CLO or lateral) is always used by only 45 - 60% of the respondents and CLO view has been rapidly adopted in clinical practice for SCS lead insertion. Direct cervicothoracic and upper thoracic is the preferred approach for cervical lead placement by the majority.

Response to: Invasive Treatments for Low Back Disorders and the ACOEM Practice Guidelines.

Response to: Invasive Treatments for Low Back Disorders and the ACOEM Practice Guidelines.

Percutaneous Spinal Cord Stimulation Lead Placement Under Deep Sedation and General Anesthesia.

IntroductionSpinal cord stimulation (SCS) is a commonly utilized therapy for the treatment of neuropathic pain conditions. The Neurostimulation Appropriateness Consensus Committee (NACC) has recommended that the placement of percutaneous SCS leads be performed in an awake patient capable of providing feedback. It is not currently known how commonly this recommendation is adhered to by physicians in clinical practice. This article presents the findings of a survey designed to answer this important question.MethodsWe conducted a survey of the active membership of the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Spine Intervention Society (SIS) regarding practice patterns with SCS therapy. We analyzed the percent of respondents who indicated that they use deep sedation and general anesthesia during SCS placement as well as any reported complications.ResultsMany practitioners frequently utilize deep sedation as well as general anesthesia when performing SCS implants. Our findings demonstrate that 77% of physicians reported that they utilize deep sedation for permanent SCS implants at times, and 45% of physicians reported the use of general anesthesia for 10 kHz implants. Additionally, 94% of physicians reported that they have never had a complication related to the use of general anesthesia for a spinal cord stimulator placement.ConclusionsThis survey provides initial data on SCS practices among a large cohort of clinicians who utilize SCS. SCS lead placement under deep sedation and general anesthesia appears to be common practice for many physicians who perform implants. This survey should stimulate further research on this topic, given that the current safety guidelines and the rate of physicians reporting the use of deep sedation and general anesthesia for spinal cord stimulator placement remain at odds.

Predictors of discogenic pain in magnetic resonance imaging: a retrospective study of provocative discography performed by posterolateral approach.

BackgroundProvocative discography (PD) is a test that is useful in diagnosing discogenic pain (DP). In this study, to diagnose DP, we used a posterolateral approach of needle placement and followed pressure criteria laid down by the Spine Intervention Society. The aim was to identify the correlation between magnetic resonance imaging (MRI) findings (desiccation, high intensity zone and change in shape and size of the disc) and the results of PD.MethodsRecords of 50 patients who underwent PD for DP were analyzed. A total of 109 PDs were performed, with 54 suspect and 55 control discs. Alternate pain generators were ruled out.ResultsA total of 35 suspect discs were positive on PD. The mean disc pressure in the suspect disc was 31.9 ± 7.9 psi (range, 15-44). Of the 50 patients who underwent PD, 35 had positive MRI findings. A significant positive correlation was found only between disc desiccation and discography result (r = 0.6, P < 0.001). Logistic regression analysis revealed that only desiccation successfully predicted the result of discography (OR = 26.5, P < 0.001); a high intensity zone and a disc protrusion/extrusion had an OR 2.3 and 1.24, respectively. Disc desiccation of Pfirmann grade 3 or more had a sensitivity and specificity of 0.93 and 0.64 respectively in identifying painful discs; the positive likelihood ratio was 2.58 while the negative likelihood ratio was 0.11.ConclusionsIn patients with DP, disc desiccation is the most useful MRI feature that predicts a painful disc on PD.

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

<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.