Thoracic Spine

What is the thoracic spine?

Your spine (backbone) is the long, flexible column of bones that protects your spinal cord. It begins at the base of your skull and ends in your tailbone, which is part of your pelvis. Your spine consists of three sections:

• Cervical spine (neck).
• Thoracic spine (upper and middle back).
• Lumbar spine (lower back).

Your thoracic spine is the middle section of your spine. It starts at the base of your neck and ends at the bottom of your ribs. It’s the longest section of your spine. Your thoracic spine consists of 12 vertebrae, labeled T1 through T12.

Vertebrae are the 33 individual, interlocking bones that form your spinal column. These bones help protect your spinal cord from injury while allowing you to twist and turn. Between the vertebral bones are disks that provide cushioning for your vertebrae and flexibility for you.

Your thoracic spine is also surrounded by muscles, nerves, tendons and ligaments that help with movement and flexibility. Your spinal cord runs through the center of your entire spine. It sends and receives messages from your brain, which controls all aspects of your body’s functions.

What is the function of the thoracic spine?

Your thoracic spine has several important functions, including:

• Protecting your spinal cord and branching spinal nerves: The nerves of your spinal cord pass through a large hole (called the vertebral foramen) in the center of all of your vertebrae in your spine. Taken together, all the stacked vertebrae of your spine form a protective central canal that protects your spinal cord.
• Providing attachments for your ribs: Thoracic vertebrae are unique in that they have the role of providing attachments for your ribs, except for the two at the bottom of your ribcage.
• Supporting your chest and abdomen: Your thoracic spine helps stabilize your rib cage, and your rib cage, in turn, helps stabilize your thoracic spine. Together, your thoracic spine and ribcage protect your heart and lungs. The joints in your thoracic spine are tight enough to protect these vital organs but loose enough to allow for the movements of breathing — inhaling and exhaling.
• Allowing movement of your body: The soft intervertebral disks between your vertebrae make it possible for you to twist and bend without sacrificing the supportive strength of your vertebral column. The joints in your thoracic spine allow you to have the greatest range of rotation of your entire spine. However, the thoracic region has the least flexion, or extension, of your entire spine.

The three sections of your spine form three natural curves. Your cervical spine (neck) and lumbar spine (low back) form “c-shaped” curves called lordosis. The thoracic vertebrae, as a group, produce a kyphotic curve, or a “reverse c-shaped” curve.

These curves are important for balance, and they help you stand upright.

What nerves branch out from the thoracic spine?

Your thoracic spine consists of 12 vertebrae numbered T1 to T12. Each number corresponds with the nerves in that section of your spinal cord, as well. These nerves branch off of your spinal cord and supply sensation (feeling) and movement to certain areas of your body. The functions of your thoracic spine nerves include:

• T1 and T2 nerves: These nerves go into the top of your chest and into your arms and hands. The T1 nerve is also part of the brachial plexus, a network of nerves in your shoulders that carries movement and sensory signals from your spinal cord to your arms and hands.
• T3 through T5 nerves: These nerves go into your chest wall. Together, these nerves help control your rib cage, lungs and diaphragm, and the muscles that help you breathe.
• T6 through T12 nerves: These nerves affect your abdominal and back muscles. These nerves, along with certain muscles, help with balance and posture, and they help you cough.

What organs are affected by the thoracic spine?

The nerves that branch off from your spinal cord in your thoracic spine transmit signals between your brain and major organs, including your:

• Lungs.
• Heart.
• Liver.
• Small intestine.

Together, your thoracic spine and rib cage provide a shield to protect your lungs and heart.

Where is the thoracic spine located?

Your thoracic spine is located in the center of your upper and middle back. It begins at the base of your neck (cervical spine) and ends around the bottom of your rib cage, just above your lower back (lumbar spine).

What is the thoracic spine made of?

Many different parts make up your thoracic spine, including:

• Vertebrae: Your thoracic spine consists of 12 of 33 stacked vertebrae (small bones) that form your spinal canal. Your spinal canal is a tunnel that houses your spinal cord and nerves, protecting them from injury. These vertebrae move to allow for a range of motion.
• Facet joints: These spinal joints have cartilage (a slippery connective tissue) that allows vertebrae to slide against each other. Facet joints let you twist and turn, and they provide flexibility and stability.
• Intervertebral disks: These flat, round cushions sit between your vertebrae and act as your spine’s shock absorbers. Each disk has a soft, gel-like center surrounded by a flexible outer ring.
• Spinal cord and nerves: Your spinal cord is a column of nerves that travels through your spinal canal. The cord extends from your skull to your lower back. Thirty-one pairs of nerves branch out through vertebral openings (the neural foramen) along your spine. Twelve pairs of nerves branch out in your thoracic spine. These nerves carry messages between your brain and muscles.
• Soft tissues: Ligaments connect your vertebrae to hold your spine in position. Muscles support your back and help you move. Tendons connect muscles to bone and aid movement.

What are common causes of thoracic spine pain?

Because your thoracic spine is much more rigid and stable, your thoracic spinal area is much less frequently injured than your lumbar (lower back) and cervical (neck) spine.

Your back has many interconnected bones, nerves, muscles, ligaments and tendons that protect your spinal cord. Experiencing pain in your thoracic region (your upper and middle back) could be due to many conditions that can affect these tissues, including:

• Muscle irritation or tension: Muscle irritation in your thoracic region is often caused by poor posture and prolonged sitting, which results in tightened muscles and pain.
• Ligament sprains: A sprain is a stretching or tearing of a ligament. A sudden twisting motion in your thoracic area of your spine can cause ligaments in that region to overstretch beyond their limit. This can cause pain in your thoracic region.
• Trauma: A fall or a direct blow to your thoracic region can cause pain. However, it takes a lot of force to fracture your thoracic spine due to its rigidity, as opposed to your cervical spine and lumbar spine. You could also experience pain in your thoracic region from ribcage injuries, which affect your thoracic nerves.
• Overuse injuries: Overuse injuries are commonly caused by repetitive motions. They cause micro-injuries to develop, which can cause spinal pain. Repetitive lifting, bending and twisting motions can contribute to overuse injuries of your thoracic spine.

More common causes of thoracic spine pain that directly involve your spinal column include:

• Spinal tumors: Spinal tumors are common and can form anywhere in and along your spine, but they most commonly occur in your middle and lower back. They’re usually a result of metastatic cancer. Back pain is the most common symptom of both benign (noncancerous) and malignant (cancerous) spinal tumors. Pain from a spinal tumor is usually aching and deep, and is persistent at night, sometimes to the point of disrupting sleep.
• Spinal fracture: Although thoracic spinal (vertebral) fractures are less common than cervical and lumbar fractures, people who have osteoporosis are more prone to thoracic spinal fractures due to having weakened bones. A sudden twisting motion or sneeze can cause thoracic spinal fractures in people with osteoporosis.

What are degenerative changes of the thoracic spine?

“Degenerative changes of the spine” is the same condition as spinal osteoarthritis, spondylosis and degenerative disk disease. With age, the soft disks that act as cushions between your spine’s vertebrae wear down, dry out and/or shrink. This narrows the space between your vertebrae, causing certain issues.

These degenerative changes are more likely to happen in your neck (cervical spine) and lower back (lumbar spine) than your upper and middle back (thoracic spine).

What are the common conditions and disorders that affect the thoracic spine?

Conditions that specifically affect your vertebrae, spinal cord and/or nerve roots in your thoracic spine, include:

• Kyphosis: Kyphosis is a spinal condition in which there’s a more forward rounding of your back, which leads to a “hunchback” or slouching posture. Kyphosis happens when the vertebrae in your upper back (thoracic spine) become more wedge-shaped. Types of kyphosis include congenital (appearing at birth), posture-related and Scheuermann’s disease.
• Pediatric and adolescent scoliosis: Pediatric and adolescent scoliosis is a condition in which a child’s spine abnormally curves sideways or rotates. Scoliosis can range from mild to severe. Your thoracic spine is usually the most affected in scoliosis. Adults can also develop scoliosis.
• Thoracic radiculopathy: Thoracic radiculopathy happens when there’s a pinched nerve root in your thoracic spine (upper back) that causes pain, tingling and/or numbness that wraps around to the front of your body. Your thoracic spine is the least common location for radiculopathy.

Other conditions that can affect any region of your spine, including your thoracic region, include:

• Bone spurs (osteophytes): Bone spurs are bone projections (growths) that develop around cartilage or tendons. They typically occur near joints in your mid-back and upper back (thoracic spine) but are more common in your cervical and lumbar spine regions.
• Herniated disk: This condition is a tear of the disks that provide a cushion between vertebrae. Intervertebral disks allow you to bend and move with ease. Herniated disks of your thoracic spine are rare compared to cervical and lumbar disk herniations.
• Myelopathy: Myelopathy describes a collection of symptoms that result from severe spinal compression. When something compresses (squeezes) your spinal cord, it can’t function properly. That can lead to pain, loss of feeling or difficulty moving certain parts of your body.
• Osteomyelitis: Osteomyelitis is a bacterial or fungal infection of the bone, in this case, the vertebrae of your spine. If left untreated, it can lead to the death of vertebrae.
• Spinal cord injury: Most spinal cord injuries come from a sudden, traumatic blow to the vertebrae in your spine, including your thoracic spine. The fractured (broken) bones then damage your spinal cord and its nerves. In rare cases, an injury can completely sever, or split, your spinal cord. Your thoracic spine has a relatively narrow vertebral canal, which makes it prone to spinal cord damage.
• Spinal stenosis: This condition happens when your spinal canal narrows. Less space within your spine reduces the amount of space available for your spinal cord and the nerves that branch off it. A tightened space can cause your spinal cord or nerves to become irritated, compressed or pinched.

What is the most common injury to the thoracic spine?

Vertebral compression fractures (VCFs) are the most common injury to the thoracic spine. They occur when a vertebra in your spine collapses, which can lead to severe pain, deformity and loss of height.

Compression fractures are especially common in the lower thoracic area, and they often result from osteoporosis and mild trauma. But they can also happen after more severe trauma in the absence of osteoporosis (such as a car crash) or as a result of tumors on your spine.

What are the symptoms of thoracic spine nerve damage?

Thoracic spine nerve and spinal cord injury symptoms depend on the type of nerve damage (incomplete or complete) and where the injury is along your thoracic spine.

The main symptoms are pain, weakness and/or tingling that radiates into your arms, legs or around your rib cage.

The following symptoms may also be associated with thoracic spine nerve damage:

• Decreased sensation or loss of sensation in your arms or legs.
• Difficulty breathing.
• Loss of feeling in your genitals or rectal region.
• Loss of bladder or bowel control.
• Constipation.

Get immediate medical attention if you notice any of these issues after an injury.

How are conditions of the thoracic spine diagnosed?

First, your healthcare provider will gather your medical and medication history, ask you about your symptoms, perform a physical exam, and order tests and imaging studies.

Tests and imaging may include:

• Computed tomography (CT) scan: This scan uses X-rays and a computer to produce detailed images of the inside of your body. A CT scan can show the shape and size of your spinal canal, its contents and the bone around it. It helps diagnose bone spurs, osteophytes, bone fusion and bone destruction from infection or tumor.
• Magnetic resonance imaging (MRI): This test uses a large magnet, radio waves and a computer to produce detailed images. It can reveal problems with your spinal cord and nerves exiting your spinal column, spinal degeneration, disk herniation, infections and tumors.
• X-rays: X-rays create pictures of your bones and soft tissues, using a small amount of radiation. X-rays can show fractures, disk problems, spinal alignment problems and the presence of arthritis.
• Electromyogram (EMG) and nerve conduction studies: An EMG helps evaluate the health and function of your nerves and muscles. A nerve conduction study measures how fast an electrical impulse moves through your nerves. These tests help determine ongoing nerve damage and the site of nerve compression.
• Myelogram: This imaging test examines the relationship between your vertebrae and disks, and outlines your spinal cord and nerves exiting your spinal column. It shows if a tumor, bone spurs or herniated disks are pressing against your spinal cord, nerves or nerve roots.

How are thoracic spine conditions treated?

Both nonsurgical treatment options, such as physical therapy and epidural steroid injections (ESIs), and surgery are available to treat many of the conditions that affect your thoracic spine.

Treatment options depend on the cause of your thoracic spine issue, its severity and your overall health. Together, you and your healthcare provider will determine the best treatment plan for you.

How can I keep my thoracic spine healthy?

There are several things you can do to keep your spine healthy, including:

• Allow your spine to rest while sleeping: Choose the right mattress and pillows to allow your spine to rest in a supported and comfortable way when you sleep. Try to keep your spine naturally aligned while you sleep with your positioning and the help of pillows.
• Strengthen your back and abdominal muscles: Muscles in your lower back and abdomen (often called your “core” muscles) need to be strong and flexible to best support your spine.
• Practice good posture and limit sitting time: Practicing good posture while seated and standing is important for supporting the natural curves of your back. Try not to sit for too long, and take frequent breaks from sitting. The disks in your lower spine are loaded more with weight while you’re sitting than when you’re standing.
• Wear supportive shoes: Good shoes provide a supportive base that helps your spine remain in alignment. Talk to your healthcare provider about what kind of shoes are best for you and if you should use orthotics or inserts.
• Maintain healthy bones: Make sure you’re getting enough vitamin D and calcium in your diet to ensure strong, healthy bones. Ask your healthcare provider about what amount is appropriate for you. This is especially important if you have or are at risk for osteoporosis.

When should I see my healthcare provider about my thoracic spine?

Because of the special structure of your thoracic spine, it’s less likely to get damaged and cause you pain than your cervical spine (neck) and lumbar spine (lower back).

Pain in your upper and middle back is more likely to be from muscle or ligament strain, which is usually temporary.

However, if you develop severe upper and/or middle back pain that’s sudden or gets worse, it’s important to see your healthcare provider, especially if you have a history of cancer. Spinal tumors are more likely to develop in this area of your spine.

It’s also important to go to the hospital as soon as possible if you experience trauma to your back, such as from a fall or vehicle accident.

A note from Cleveland Clinic

The thoracic region of your spine has several important functions. While spinal injuries are less common in your thoracic spine compared to your cervical and lumbar spine, it’s important to see your healthcare provider if you’re experiencing persistent pain in your upper or middle back. They can perform a physical exam and order tests to see what could be causing your pain.