Thoracic spine fractures are frequently caused by an acute traumatic event such as a fall from height or a high speed accident. Another very common cause is osteoporosis, in which a compression fracture can occur with little to no trauma because of the poor bone quality (please see section on compression fractures and osteoporosis). Lastly, thoracic spine fractures can be caused by a pathological process such as a metastatic tumor which destroys the bone tissue.
Localized back pain is a cardinal feature of thoracic fractures irrespective of the exact cause. In cases in which the fracture results in injury to the spinal cord, patients may present with varying degrees of neurological dysfunction in the lower extremities and bowel and bladder.
Thoracic spine fractures can be diagnosed using plain x-ray and/or CT scans. MRI does not demonstrate the boney injury as well as the two aforementioned modalities, but is commonly used to assess the degree of ligamentous soft tissue injury and spinal canal narrowing. Various types of bone scans can be used to help identify pathological fractures, as well as the healing status of known fractures.
The thoracic spine is inherently more stable than the cervical or lumbar spine due to the support afforded by the ribs and sternum, as well as the shape and orientation of its posterior elements. Consequently, many thoracic fractures can be treated nonoperatively using a TLSO brace. Surgery can consist of outpatient procedures such as vertebroplasty or kyphoplasty for some compression fractures, or very large spinal reconstruction fusion procedures for unstable spinal fractures with or without neurological injury.