Skip to main content
SpringerLink
Log in

Thoracic Epidural Injections

  • Chapter
  • First Online:
Essentials of Interventional Techniques in Managing Chronic Pain

Abstract

The prevalence of mid- and upper back chronic pain is significantly lower than low back and neck pain with reports showing pain of thoracic origin in 5–15% of the patients, compared to 24–44% with neck pain and 33–56% with low back pain. Thoracic intervertebral discs, nerve roots, and facet joints are capable of transmitting pain in the thoracic spine with radiation into the chest wall and abdominal wall. Chronic, persistent thoracic and chest wall pain and radicular pain may be secondary to disc herniation, discogenic pain, spinal stenosis, or post-thoracic surgery syndrome.

Epidural injections are one of the commonly utilized treatment modalities for managing chronic thoracic pain administered by either interlaminar approach or transforaminal approach. There is significant paucity of literature concerning thoracic epidural injections in managing chronic pain, with only one high-quality randomized controlled trial, leading to Level II evidence for thoracic interlaminar epidural injections with no evidence available for thoracic transforaminal epidural injections.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Linton SJ, Halldén K. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain. 1998;14:209–15.

    Article  CAS  PubMed  Google Scholar 

  2. Anderson R, Meeker WC, Wirick BE, et al. A metaanalysis of clinical trials of spinal manipulation. J Manip Physiol Ther. 1992;15:181–94.

    CAS  Google Scholar 

  3. Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques of chronic spinal pain: part II: guidance and recommendations. Pain Physician. 2013;16:S49–S283.

    PubMed  Google Scholar 

  4. Goebert HW Jr, Jallo SJ, Gardner WJ, et al. Painful radiculopathy treated with epidural injections of procaine and hydrocortisone acetate: results in 113 patients. Anesth Analg. 1961;40:130–4.

    Article  PubMed  Google Scholar 

  5. Wang A, Pilgram TK, Gilula LA. Immediate complications and pain relief associated with 296 fluoroscopically guided thoracic foraminal nerve blocks. AJR Am J Roentgenol. 2011;197:1410–6.

    Article  PubMed  Google Scholar 

  6. Rosas HG, Gilula LA. Performing thoracic transforaminal injections: a new technique. Radiology. 2010;254:595–600.

    Article  PubMed  Google Scholar 

  7. Benyamin RM, Wang VC, Vallejo R, et al. A systematic evaluation of thoracic interlaminar epidural injections. Pain Physician. 2012;15:E497–514.

    PubMed  Google Scholar 

  8. Manchikanti L, Cash KA, McManus CD, et al. Thoracic interlaminar epidural injections in managing chronic thoracic pain: a randomized, double-blind, controlled trial with a 2-year follow-up. Pain Physician. 2014;17:E327–38.

    PubMed  Google Scholar 

  9. Graybill J, Conermann T, Kabazie AJ, et al. Spinal cord stimulation for treatment of pain in a patient with post thoracotomy pain syndrome. Pain Physician. 2011;14:441–5.

    PubMed  Google Scholar 

  10. Manchikanti L, Singh V, Falco FJE, et al. The role of thoracic medial branch blocks in managing chronic mid and upper back pain: a randomized, double-blind, active-control trial with a 2-year follow-up. Anesthesiol Res Pract. 2012;2012:585806.

    PubMed  PubMed Central  Google Scholar 

  11. Singh V, Manchikanti L, Onyewu O, et al. An update of appraisal of accuracy of thoracic discography as a diagnostic test for chronic spinal pain. Pain Physician. 2012;15:E757–76.

    PubMed  Google Scholar 

  12. Manchikanti L, Helm S II, Singh V, et al. Accountable interventional pain management: a collaboration among practitioners, patients, payers, and government. Pain Physician. 2013;16:E635–70.

    PubMed  Google Scholar 

  13. Awaad EE, Martin DW, Smith KR Jr. Asymptomatic versus symptomatic herniated thoracic discs: their frequency and characteristics as detected by computed tomography after myelography. Neurosurgery. 1991;28:180–6.

    Article  Google Scholar 

  14. Williams MP, Cherryman GR, Husband JE. Significance of thoracic disc herniation demonstrated by MR imaging. J Comput Assist Tomogr. 1989;13:211–4.

    Article  CAS  PubMed  Google Scholar 

  15. Yoshihara H. Surgical treatment for thoracic disc herniation: an update. Spine (Phila Pa 1976). 2014;39:E406–12.

    Article  Google Scholar 

  16. Dietze DD, Fessler RG. Thoracic disc herniations. Neurosurg Clin N Am. 1993;4:75–90.

    PubMed  Google Scholar 

  17. Glaser SE, Falco FJE. Paraplegia following a thoracolumbar transforaminal epidural steroid injection. Pain Physician. 2005;8:309–14.

    PubMed  Google Scholar 

  18. Glaser SE, Shah RV. Root cause analysis of paraplegia following transforaminal epidural steroid injections: the ‘unsafe’ triangle. Pain Physician. 2010;13:237–44.

    PubMed  Google Scholar 

  19. Shah RV. Paraplegia following thoracic and lumbar transforaminal epidural steroid injections: how relevant are particulate steroids? Pain Pract. 2014;14:297–300.

    Article  PubMed  Google Scholar 

  20. U.S. Food and Drug Administration. Drug Safety Communications. FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. www.fda.gov/downloads/Drugs/DrugSafety/UCM394286.pdf.

  21. Food and Drug Administration. Anesthetic and analgesic drug products advisory committee meeting. 2014 Nov 24–25; Epidural steroid injections (ESI) and the risk of serious neurologic adverse reactions. www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndAnalgesicDrugProductsAdvisoryCommittee/UCM422692.pdf.

  22. Manchikanti L, Candido KD, Singh V, et al. Epidural steroid warning controversy still dogging FDA. Pain Physician. 2014;17:E451–74.

    PubMed  Google Scholar 

  23. Manchikanti L, Falco FJE, Benyamin RM, et al. Epidural steroid injections safety recommendations by the Multi-Society Pain Workgroup (MPW): more regulations without evidence or clarification. Pain Physician. 2014;17:E575–88.

    PubMed  Google Scholar 

  24. Rathmell JP, Benzon HT, Dreyfuss P, et al. Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology. 2015. Epub ahead of print.

    Google Scholar 

  25. Manchikanti L, Falco FJE. Safeguards to prevent neurologic complications after epidural steroid injections: analysis of evidence and lack of applicability of controversial policies. Pain Physician. 2015;18:E129–38.

    PubMed  Google Scholar 

  26. Manchikanti L, Benyamin RM. Key safety considerations when administering epidural steroid injections. Pain Manag. 2015;10:1–12. Epub ahead of print

    Google Scholar 

  27. Manchikanti L, Hirsch JA. Neurological complications associated with epidural steroid injections. Curr Pain Headache Rep. 2015;19:482.

    Article  PubMed  Google Scholar 

  28. Pages E. Anesthesia metamerica. Rev Sanid Mil Madr. 1921;11:351–85.

    Google Scholar 

  29. Dogliotti AM. Segmental peridural anesthesia. Am J Surg. 1933;20:107–18.

    Article  Google Scholar 

  30. Gutierrez A. Valor de la aspiracion liquada en al espacio peridural en la anesthesia peridural. Rev Circ. 1933;12:225.

    Google Scholar 

  31. Bogduk N. Thoracic transforaminal access. In: Practice guidelines for spinal diagnostic and treatment procedures. 2nd ed. San Francisco: International Spine Intervention Society (ISIS); 2013. p. 329–45.

    Google Scholar 

  32. Cooper RG, Freemont AJ, Hoyland JA, et al. Herniated intervertebral disc-associated periradicular fibrosis and vascular abnormalities occur without inflammatory cell infiltration. Spine (Phila Pa 1976). 1995;20:591–8.

    Article  CAS  Google Scholar 

  33. Manchikanti L, Singh V, Datta S. Thoracic and chest wall pain and radicular pain. In: Manchikanti L, Christo PJ, Trescot AM, Falco FJE, editors. Clinical aspects of pain medicine and interventional pain management: a comprehensive review. Paducah: ASIPP Publishing; 2011. p. 61–86.

    Google Scholar 

  34. Botwin KB, Vettichira S. Thoracic interlaminar epidural steroid injections. In: Manchikanti L, Singh V, editors. Interventional techniques in chronic spinal pain. Paducah: ASIPP Publishing; 2007. p. 383–400.

    Google Scholar 

  35. Lee HM, Weinstein JN, Meller ST. The role of steroids and their effect on phospholipase A2. An animal model of radiculopathy. Spine (Phila Pa 1976). 1998;23:1191–6.

    Article  CAS  Google Scholar 

  36. Minamide A, Tamaki T, Hashizume H. Effects of steroids and lipopolysaccharide on spontaneous resorption of herniated intervertebral discs. An experimental study in the rabbit. Spine (Phila Pa 1976). 1998;23:870–6.

    Article  CAS  Google Scholar 

  37. Korovessis PG. The role of steroids and their effects on phospholipase A2. Spine (Phila Pa 1976). 2000;25:2004–5.

    Article  CAS  Google Scholar 

  38. Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibers. Acta Anaesthesiol Scand. 1990;34:335–8.

    Article  CAS  PubMed  Google Scholar 

  39. Hayashi N, Weinstein JN, Meller ST, et al. The effect of epidural injection of betamethasone or bupivacaine in a rat model of lumbar radiculopathy. Spine (Phila Pa 1976). 1999;8:877–85.

    Google Scholar 

  40. Manchikanti L, Singh V. Corticosteroids. In: Manchikanti L, Christo PJ, Trescot AM, Falco FJE, editors. Foundations of pain medicine and interventional pain management: a comprehensive review. Paducah: ASIPP Publishing; 2011. p. 589–606.

    Google Scholar 

  41. Sato C, Sakai A, Ikeda Y, et al. The prolonged analgesic effect of epidural ropivacaine in a rat model of neuropathic pain. Anesth Analg. 2008;106:313–20.

    Article  CAS  PubMed  Google Scholar 

  42. Tachihara H, Sekiguchi M, Kikuchi S, et al. Do corticosteroids produce additional benefit in nerve root infiltration for lumbar disc herniation. Spine (Phila Pa 1976). 2008;33:743–7.

    Article  Google Scholar 

  43. Pasqualucci A, Varrassi G, Braschi A, et al. Epidural local anesthetic plus corticosteroid for the treatment of cervical brachial radicular pain: single injection versus continuous infusion. Clin J Pain. 2007;23:551–7.

    Article  PubMed  Google Scholar 

  44. Arner S, Lindblom U, Meyerson BA, et al. Prolonged relief of neuralgia after regional anesthetic block. A call for further experimental and systematic clinical studies. Pain. 1990;43:287–97.

    Article  CAS  PubMed  Google Scholar 

  45. Bicket M, Gupta A, Brown CH, et al. Epidural injections for spinal pain: a systematic review and meta-analysis evaluating the “control” injections in randomized controlled trials. Anesthesiology. 2013;119:907–31.

    Article  PubMed  Google Scholar 

  46. Manchikanti L, Nampiaparampil DE, Manchikanti KN, et al. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: a systematic review of randomized controlled trials. Surg Neurol. 2015;6:S194–235.

    Article  Google Scholar 

  47. Kaye AD, Manchikanti L, Abdi S, et al. Efficacy of epidural injections in managing chronic spinal pain: a best evidence synthesis. Pain Physician. 2015 (in press).

    Google Scholar 

  48. Manchikanti L, Falco FJE, Benyamin RM, et al. A modified approach to grading of evidence. Pain Physician. 2014;17:E319–25.

    PubMed  Google Scholar 

  49. Netter FH. Atlas of Human Anatomy. 4th ed. Philadelphia: Saunders, Elsevier; 2006.

    Google Scholar 

  50. Drake R, Vogl W, Mitchell A. Gray’s anatomy for students. Philadelphia: Elsevier; 2005. p. 14–99.

    Google Scholar 

  51. Standring S. Macroscopic anatomy of the spinal cord and spinal nerves. In: Standring S, editor. Gray’s anatomy: the anatomical basis of clinical practice. 39th ed. London: Elsevier/Churchill Livingstone; 2005. p. 775–88.

    Google Scholar 

  52. Standring S. The back. In: Standring S, editor. Gray’s anatomy: the anatomical basis of clinical practice. 39th ed. London: Elsevier/Churchill Livingstone; 2005. p. 733–74.

    Google Scholar 

  53. Bowsher DA. Comparative study of the azygous venous system in man, monkey, dog, cat, rat and rabbit. J Anat. 1954;88:400–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Lirk P, Kolbitsch C, Putz G, et al. Cervical and high thoracic ligamentum flavum frequently fails to fuse in the midline. Anesthesiology. 2003;99:1387–90.

    Article  PubMed  Google Scholar 

  55. Blomberg R. The dorsomedian connective tissue band in the lumbar epidural space of humans: an anatomical study using epiduroscopy in autopsy cases. Anesth Analg. 1986;65:747–52.

    Article  CAS  PubMed  Google Scholar 

  56. Woollam DHM, Millen JW. The arterial supply of the spinal cord and its significance. J Neurochem. 1955;18:97–102.

    CAS  Google Scholar 

  57. Morishita K, Murakami G, Fujisawa Y, et al. Anatomical study of blood supply to the spinal cord. Ann Thorac Surg. 2003;76:1967–71.

    Article  PubMed  Google Scholar 

  58. Shenouda P, Cunningham B. Assessing the superiority of saline versus air for use in the epidural loss-of-resistance technique: a literature review. Reg Anesth Pain Med. 2003;28:48–53.

    Article  PubMed  Google Scholar 

  59. Mehta S, Khalil AA, Alshekhlee A. Air myelopathy following a cervical epidural injection. Pain Med. 2010;11:1678–9.

    Article  PubMed  Google Scholar 

  60. Kim TS, Shin SS, Kim JR, et al. Air bubbles mimic disc herniation in MRI after cervical epidural block. Korean J Pain. 2010;23:202–6.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Rathmell JP. Atlas of image-guided intervention in regional anesthesia and pain medicine. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2012.

    Google Scholar 

  62. Manchikanti L, Malla Y, Wargo BW, et al. A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections. Pain Physician. 2012;15:131–40.

    PubMed  Google Scholar 

  63. Ajar AM, Rathmel JP, Mukherji SK. The subdural compartment. Reg Anesth Pain Med. 2002;27:72–6.

    Article  PubMed  Google Scholar 

  64. Collier CB. Accidental subdural block: four more cases and a radiographic review. Anaesth Intensive Care. 1992;20:215–32.

    CAS  PubMed  Google Scholar 

  65. Collier CB. Accidental subdural injection during attempted lumbar epidural block may present as a failed or inadequate block: radiographic evidence. Reg Anesth Pain Med. 2004;29:45–51.

    PubMed  Google Scholar 

  66. Atluri S, Glaser SE, Shah RV, et al. Needle position analysis in cases of paralysis from transforaminal epidurals: consider alternative approaches to traditional techniques. Pain Physician. 2013;16:321–34.

    PubMed  Google Scholar 

  67. Alleyne CH Jr, Cawley CM, Shengelaia GG, et al. Microsurgical anatomy of the artery of Adamkiewicz and its segmental artery. J Neurosurg. 1998;89:791–5.

    Article  PubMed  Google Scholar 

  68. Kroszczynski AC, Kohan K, Kurowski M, et al. Intraforaminal location of thoracolumbar anterior medullary arteries. Pain Med. 2013;14:808–12.

    Article  PubMed  Google Scholar 

  69. Rauschning W. Normal and pathological anatomy of the nerve root canals. Spine (Phila Pa 1976). 1987;2:1008–19.

    Article  Google Scholar 

  70. van Roy P, Barbaix E, Clarijs JP, et al. Anatomical background of low back pain: variability and degeneration of the lumbar spinal canal and intervertebral disc. Schmerz. 2001;15:418–24.

    Article  PubMed  Google Scholar 

  71. Murthy NS, Maus TP, Behrns CL. Intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz): a retrospective review. Pain Med. 2010;11:1756–64.

    Article  PubMed  Google Scholar 

  72. Takase K, Sawamura Y, Igarashi K, et al. Demonstration of the artery of Adamkiewicz at multi–detector row helical CT. Radiology. 2002;223:39–45.

    Article  PubMed  Google Scholar 

  73. Shah RV. Paraplegia following thoracic and lumbar transforaminal epidural steroid injections: how relevant is physician negligence? J Neurointerv Surg. 2014;6:166–8.

    Article  PubMed  Google Scholar 

  74. Manchikanti L, Schultz DM, Atluri S, et al. Lumbar epidural injections. In: Manchikanti L, Kaye AD, Falco FJE, et al., editors. Essentials of interventional techniques in managing chronic pain. New York: Springer; 2017.

    Google Scholar 

  75. Manchikanti L, Schultz DM, Glaser SE, et al. Cervical epidural injections. In: Manchikanti L, Kaye AD, Falco FJE, et al., editors. Essentials of interventional techniques in management of chronic pain. New York: Springer; 2017.

    Google Scholar 

  76. Visnjevac O, Kim P, Farid-Davari S, et al. Digital subtraction angiography versus real-time fluoroscopy for detection of intravascular penetration prior to epidural steroid injections: meta-analysis of prospective studies. Pain Physician. 2015;18:29–36.

    PubMed  Google Scholar 

  77. Chang-Chien GC, Candido KD, Knezevic NN. Digital subtraction angiography does not reliably prevent paraplegia associated with lumbar transforaminal epidural steroid injection. Pain Physician. 2012;15:515–23.

    PubMed  Google Scholar 

  78. Chien GC, Candido KD. Digital subtraction angiography is not the answer for safe epidural injections. Pain Physician. 2014;17:E413–4.

    PubMed  Google Scholar 

  79. Lyders EM, Morris PP. A case of spinal cord infarction following lumbar transforaminal epidural steroid injection: MR imaging and angiographic findings. AJNR Am J Neuroradiol. 2009;30:1691–3.

    Article  CAS  PubMed  Google Scholar 

  80. Giebler RM, Scherer R, Peters J. Incidence of neurologic complications related to thoracic epidural catheterization. Anesthesiology. 1997;86:55–63.

    Article  CAS  PubMed  Google Scholar 

  81. Zaugg M, Stoehr S, Weder W. Accidental plural puncture by a thoracic epidural catheter. Anesthesia. 1998;53:69–78.

    Article  CAS  Google Scholar 

  82. Bromage PR, Benumof JL. Paraplegia following intracord injection during attempted epidural anesthesia under general anesthesia. Reg Anesth Pain Med. 1998;23:104–7.

    Article  CAS  PubMed  Google Scholar 

  83. Windsor RE, Storm S, Sugar R. Prevention and management of complications resulting from common spinal injections. Pain Physician. 2003;6:473–83.

    PubMed  Google Scholar 

  84. Mayall MF, Calder I. Spinal cord injury following an attempted thoracic epidural. Anaesthesia. 1999;54:990–4.

    Article  CAS  PubMed  Google Scholar 

  85. Aldrete JA, Ferrari H. Myelopathy with syringomyelia following thoracic epidural anaesthesia. Anaesth Intensive Care. 2004;32:100–3.

    CAS  PubMed  Google Scholar 

  86. Perrson J, Flisberg P, Lundberg J. Thoracic epidural anesthesia and epidural hematoma. Acta Anaesthesiol Scand. 2002;46:1171–4.

    Article  Google Scholar 

  87. Grieve PP, Whitta RK. Pleural puncture: an unusual complication of a thoracic epidural. Anaesth Intensive Care. 2004;32:113–6.

    CAS  PubMed  Google Scholar 

  88. Sklar EML, Quencer RM, Green BA. Complications of epidural anesthesia: MR appearance of abnormalities. Radiology. 1991;181:549–54.

    Article  CAS  PubMed  Google Scholar 

  89. Manchikanti L. Role of neuraxial steroids in interventional pain management. Pain Physician. 2002;5:182–99.

    PubMed  Google Scholar 

  90. Botwin KP, Baskin M, Rao S. Adverse effects of fluoroscopically guided interlaminar thoracic epidural steroid injections. Am J Phys Med Rehabil. 2006;85:14–23.

    Article  PubMed  Google Scholar 

  91. Manchikanti L, Falco FJE, Benyamin RM, et al. Assessment of bleeding risk of interventional techniques: a best evidence synthesis of practice patterns and perioperative management of anticoagulant and antithrombotic therapy. Pain Physician. 2013;16:SE261–318.

    PubMed  Google Scholar 

  92. Horlocker TT, Wedel DJ, Rowlingson JC, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine evidence-based guidelines (third edition). Reg Anesth Pain Med. 2010;35:64–101.

    Article  CAS  PubMed  Google Scholar 

  93. International Spine Intervention Society. Anticoagulants. In: Bogduk N, editor. Practice guidelines for spinal diagnostic and treatment procedures. 2nd ed. San Francisco: International Spine Intervention Society; 2013. p. 9–17.

    Google Scholar 

  94. Manchikanti L, Malla Y, Wargo BW, et al. A prospective evaluation of bleeding risk of interventional techniques in chronic pain. Pain Physician. 2011;14:317–29.

    PubMed  Google Scholar 

  95. Gogarten W, Vandermeulen E, Van Aken H, et al. European Society of Anaesthesiology. Regional anaesthesia and antithrombotic agents: recommendations of the European Society of anaesthesiology. Eur J Anaesthesiol. 2010;27:999–1015.

    Article  CAS  PubMed  Google Scholar 

  96. Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA consensus conference on neuraxial anesthesia and anticoagulation). Reg Anesth Pain Med. 2003;28:172–97.

    PubMed  Google Scholar 

  97. Raj PP, Shah RV, Kaye AD, et al. Bleeding risk in interventional pain practice: assessment, management, and review of the literature. Pain Physician. 2004;7:3–52.

    PubMed  Google Scholar 

  98. Manchikanti L, Kaye AD, Falco FJE. Antithrombotic and antiplatelet therapy. In: Manchikanti L, Kaye AD, Falco FJE, et al., editors. Essentials of interventional techniques in managing chronic pain. New York: Springer; 2017.

    Google Scholar 

  99. Rose A. Periprocedural anticoagulation – adult – inpatient and ambulatory– clinical practice guideline. UW Health, Original Oct 2011, Revised Feb 2013. http://www.uwhealth.org/files/uwhealth/docs/anticoagulation/Periprocedural_Anticoagulation_Guideline.pdf.

Download references

Acknowledgments

This book chapter is modified and updated from a previous book chapter, “Thoracic Interlaminar Epidural Steroid Injections” by Kenneth P. Botwin, MD and Susan Vettichira, MD, in Interventional Techniques in Chronic Spinal Pain published by ASIPP Publishing. Permission has been obtained from ASIPP Publishing.

Author information

Authors and Affiliations

  1. Pain Management Center of Paducah, Paducah, KY, USA

    Laxmaiah Manchikanti

  2. Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA

    Laxmaiah Manchikanti

  3. Medical Advanced Pain Specialists Medical Pain Clinics, Shorewood, MN, USA

    David M. Schultz

  4. Pain Specialists of Greater Chicago, Burr Ridge, IL, USA

    Scott E. Glaser

  5. Mid Atlantic Spine and Pain Physicians, Newark, DE, USA

    Frank J. E. Falco

  6. Pain Medicine Fellowship Program, Temple University Hospital, Philadelphia, PA, USA

    Frank J. E. Falco

  7. Temple University Medical School, Philadelphia, PA, USA

    Frank J. E. Falco

Authors
  1. Laxmaiah Manchikanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David M. Schultz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott E. Glaser
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frank J. E. Falco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laxmaiah Manchikanti .

Editor information

Editors and Affiliations

  1. Pain Management Center of Paducah, Paducah, Kentucky

    Laxmaiah Manchikanti

  2. Department of Anesthesia, LSU Health Science Center, New Orleans, Louisiana, USA

    Alan D. Kaye

  3. Mid Atlantic Spine and Pain Physicians, Newark, Delaware

    Frank J.E. Falco

  4. Service Line Chief of Interventional Radiology, Director of Interventional Neuroradiology, Chief of NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, Massachusetts, USA

    Joshua A. Hirsch

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Manchikanti, L., Schultz, D.M., Glaser, S.E., Falco, F.J.E. (2018). Thoracic Epidural Injections. In: Manchikanti, L., Kaye, A., Falco, F., Hirsch, J. (eds) Essentials of Interventional Techniques in Managing Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-60361-2_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-60361-2_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60359-9

  • Online ISBN: 978-3-319-60361-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation