The upper back is referred to as the thoracic spine. It is comprised of 12 vertebrae, numbered T1 through T12. The neck is referred to as the cervical spine and is comprised of 7 bones and the low back is referred to as the lumbar spine and is comprised of 5 bones. The upper back, or thoracic spine, does not degenerate or become symptomatic as commonly as the neck and low back. Part of the reason is that the ribs help to stabilize and support the thoracic spine. There is less motion and therefore less wear and tear on the thoracic spine as opposed to the neck or low back.
A common complaint is pain in between the shoulder blades. This is often radiating or originating from the neck. Degenerative disc disease, spinal stenosis and facet arthropathy of the cervical spine is the most common underlying cause of neck pain and pain that radiates into the upper back.
In younger patients, such as teenagers or young adults, a wedging or collapse of the anterior aspect of the thoracic vertebrae and disc can create an exaggerated forward flexed deformity known as Scheumerman’s kyphosis. This can often result in upper back pain.
In the elderly, multiple wedge shaped compression fractures of the vertebrae and degenerative disc disease can contribute to a “hunched back” kyphotic deformity as well. The treatment for this is typically pain control unless there is an acute compression fracture from underlying osteoporosis. Bone density scans can be done to evaluate for underlying osteoporosis and MRI’s can help determine if a compression fracture (collapse of a vertebrae) is acute or chronic. If it is acute the treatment options are either bracing for 8-12 weeks or a 15 minute outpatient minimally invasive procedure called a kyhpoplasty. In this procedure a small needle is introduced into the broken (fractured/compressed) bone and cement is placed. The purpose of this is to stabilize the bone so it does not collapse further, thereby helping to prevent further imbalance of the spine. The cement also typically decreases pain significantly allow the patient to take less or no pain medication and become more mobile.