Thoracic Epidural Injection

Fluoroscopically guided thoracic epidural steroid injections to relieve mid-back pain, band-like chest wall pain, and thoracic radiculopathy — performed by board-certified pain management physicians at Remix Medical in Houston, TX.

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Thoracic Epidural Steroid Injection in Houston, Texas

The thoracic spine is the least mobile and least commonly injured region of the back, which is exactly why thoracic pain is so often misattributed. When a thoracic disc or nerve root is genuinely the source, pain wraps around the chest wall in a band rather than travelling down a limb, and it can convincingly imitate cardiac or abdominal disease.

What is a Thoracic Epidural Injection?

A thoracic epidural steroid injection delivers corticosteroid and local anesthetic into the epidural space of the mid-back, under fluoroscopic guidance, to reduce inflammation around a compressed or irritated thoracic nerve root.

The thoracic epidural space is narrow and sits directly over the spinal cord, so this procedure demands meticulous image guidance and is performed only by physicians experienced with the anatomy.

When It Is Used

Thoracic radiculopathy with band-like pain wrapping around the ribs
Thoracic disc herniation , which is uncommon but can be highly symptomatic
Post-herpetic neuralgia following shingles in a thoracic dermatome
Post-thoracotomy pain after chest surgery
Compression fracture pain in selected patients

What Makes It Different

Unlike the lumbar spine, the thoracic spinal cord occupies most of the canal, and unlike the cervical spine, the ribs constrain access. The interlaminar windows are small and angled steeply. These constraints mean the procedure is done under continuous fluoroscopy with contrast confirmation before any steroid is delivered.

Because thoracic pain is frequently referred from elsewhere, a careful workup precedes any injection. Cardiac, pulmonary, and abdominal causes must be excluded first.

Relief from Mid-Back and Chest Wall Pain at Remix Medical

Thoracic pain that has been dismissed, or attributed to muscle strain for months, deserves a proper evaluation.

How it's performed

With the patient prone under live fluoroscopy, the skin and deeper tissues are anesthetized. A needle is advanced into the thoracic epidural space using a carefully angled interlaminar or transforaminal approach appropriate to the narrow thoracic anatomy. Contrast confirms epidural spread and excludes vascular or intrathecal placement before corticosteroid and local anesthetic are injected.

How to prepare

Arrange a driver. Hold anticoagulants only as directed by the prescribing physician. Bring recent thoracic imaging and a current medication list. Cardiac and pulmonary causes of chest wall pain should be excluded before the procedure. Notify the office of any active infection or fever.

What to expect after

Ice the injection site 20 minutes every 2 to 3 hours for the first day. Avoid strenuous activity and heavy lifting for 24 to 48 hours. A temporary increase in pain for 1 to 2 days is common. Monitor blood glucose if diabetic. Report fever, severe headache, shortness of breath, or new weakness immediately.

Outcome

Appropriately selected patients typically experience reduced band-like chest wall or mid-back pain lasting weeks to months, often enough to allow progression with physical therapy and reduction of oral medication.

Your physician

Your pain management at Remix Medical.

Every clinician at Remix Medical is board-certified and owns the practice — so the physician in your exam room is the one making decisions about your care.

Raju Mantena, DO
Pain Medicine Physician
Medical Center — South Freeway · Montrose — Upper Kirby · Pearland
Board certifiedAccepting newBook

Specialty: Pain Management
Type: Procedure
Body location: Thoracic spine, thoracic epidural space, thoracic nerve roots, intercostal nerves
CPT code: 62320 (interlaminar, without imaging), 62321 (interlaminar, with imaging); 64479 (transforaminal, cervical/thoracic, single level), 64480 (each additional level)

Also known as: Thoracic ESI, Mid-Back Epidural Injection, Thoracic Epidural Steroid Injection

This page is for general education and is not a substitute for medical advice. Whether a given procedure is appropriate depends on your individual evaluation. Contact a Remix Medical clinician to discuss your care.

Updated July 9, 2026.