Abstract: Thoracic back pain, while less prevalent than cervical or lumbar pain, encompasses a wide spectrum of conditions ranging from benign to life-threatening. This article discusses both non-spine-related causes, such as aortic dissection and pancreatitis, as well as spine-related pathology including compression fractures, herpetic neuralgia, thoracic disc herniations, spinal metastases, and intradural lesions like meningiomas and syringomyelia. Using clinical pearls, case studies, and evidence-based approaches, this article offers primary healthcare providers with the tools to diagnose and manage thoracic back pain effectively.
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Spinal Compression Fractures: Most commonly caused by osteoporosis, compression fractures present with acute pain exacerbated by movement. Prevention efforts focus on frailty screening and osteoporosis management.
Herpetic Neuralgia: Thoracic dermatomes are frequently affected, with dermatomal pain and vesicular rash often confirming the diagnosis. Neuropathic pain agents remain the cornerstone of treatment.
Thoracic Disc Herniation: Though rare (1:1,000,000), can cause thoracic pain and radiculopathy and lead to myelopathy with spastic paraparesis. MRI is the gold standard for diagnosis, with surgical interventions considered for refractory cases.
Spinal Metastasis: The thoracic spine is the most common site for spinal metastases, presenting with nocturnal pain, neurologic deficits, and instability. Treatment involves palliation, pain relief, and spinal stabilization.
Thoracic viscera may be the source of sudden severe pain, often associated with hemodynamic or constitutional symptoms.
MRI is the preferred imaging modality for diagnosing thoracic disc herniation, spinal cord compression, and intramedullary lesions.
Early recognition and referral to specialists are crucial for conditions like thoracic disc herniation, unstable spinal metastatic disease, and syrinx to improve patient outcomes.
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