The thoracic spine is the middle portion of the spine, extending from the base of the neck to the upper lower back. It is made up of 12 vertebrae, labeled T1 through T12. Compared with the cervical and lumbar spine, the thoracic spine is naturally more stable because the ribs and chest wall provide additional support.
Please review the Thoracic spine anatomy section for more information.
Despite this stability, certain conditions can cause abnormal movement, loss of alignment, or failure of the bones to remain firmly connected. These conditions are collectively referred to as thoracic spinal instability disorders.
Thoracic instability may cause back pain, progressive spinal deformity, or compression of the spinal cord. Because the spinal cord travels through the entire thoracic spine, significant instability can sometimes lead to problems with walking, balance, strength, or bowel and bladder function.
Major Diagnosis Types
Below are the major types we see in our clinic. Click on available links to learn about our approach to the problems.
Adjacent Segment Disease
Adjacent segment disease can occur after a spinal fusion. The vertebrae included in a successful fusion no longer move independently, which can place additional mechanical stress on the spinal segments immediately above or below the fusion.
Changes seen on imaging alone are often called adjacent segment degeneration. The term adjacent segment disease is generally used when those changes begin producing symptoms, and my require treatment.
Pseudarthrosis
A pseudarthrosis is a spinal fusion that has failed to completely heal. It is sometimes called a nonunion.
After spinal fusion surgery, bone is placed between vertebrae with the goal of forming one solid piece of bone. Screws and rods maintain stability while the fusion heals.
If adequate bone growth does not occur, continued movement can remain at the surgical level. This problem can cause symptoms that may require additional treatment.
Minor Diagnosis Types
These terms are often encountered, but are either less often treated or described within one of the above diagnoses.
Thoracic Spondylolisthesis
Thoracic spondylolisthesis occurs when one thoracic vertebra moves forward or backward relative to the vertebra next to it.
Spondylolisthesis is much more common in the lumbar spine. It is rare in the thoracic spine because the rib cage provides substantial additional stability.
Treatment depends on the amount of movement, symptoms, spinal alignment, and whether the spinal cord is compressed.
Thoracic Instability
Thoracic instability describes abnormal movement or inadequate structural support between thoracic vertebrae.
Instability can develop gradually or occur suddenly. Causes may include degeneration, fracture, deformity, previous surgery, infection, or tumors that weaken the vertebrae.
If the spine is clearly unstable, surgery may be necessary to restore and maintain alignment. Pedicle screws and rods can be used to stabilize the affected vertebrae while bone grows between them to create a solid spinal fusion.