Mid-Back (Thoracic)
Thoracic Spondylosis
흉추 척추증
Chronic thoracic pain from degenerative changes
- How common
- Common in elderly
- Typical age
- Age 60+
What is it?
Cumulative degeneration of discs, facets, and ligaments causes axial pain and stiffness.
Commonly affected: Predominantly mid-lower thoracic (T6-T12)
How it develops
- Disc DehydrationLoss of disc hydration
- Disc Space NarrowingReduced disc height
- Osteophyte FormationVertebral body osteophytes
- Facet DegenerationFacet cartilage wear, capsular thickening
Symptoms
- Chronic mid-back painDeep, dull ache
- Morning stiffnessResolves within 30–60 min
- Activity-related painWorse with prolonged posture
- Decreased ROMLimited thoracic rotation/extension
How it is examined
- Thoracic tendernessSpinous process and paraspinal tenderness
- Reduced ROMRotation <30°, extension <15°
- Normal neurologic examNo radicular symptoms; normal motor/reflex
- Postural assessmentIncreased thoracic kyphosis possible
Imaging
Lateral X-ray is primary — osteophytes, disc narrowing, kyphosis.
- Disc space narrowing
- Anterior osteophytes
- Facet sclerosis
- Increased kyphosis
MRI when neurologic signs — evaluates cord and roots.
- Disc dehydration (T2↓)
- Facet hypertrophy
- Possible canal narrowing
Non-surgical care
- Postural exercisesThoracic extension and scapular stabilization
- NSAIDs / acetaminophenShort-term analgesia
- Heat/massageMuscle relaxation, circulation
- Facet injectionImage-guided injection for severe cases
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Myelopathy or severe structural deformity
Procedures that may be discussed
- Posterior decompression
- Fusion
Outlook
Most manage with conservative care.