More than one procedure can be considered usually appropriate in the initial imaging evaluation when: The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org OR Discussion of Procedures by Variant Variant 1: Adult. Acute Thoracic back pain without myelopathy or radiculopathy. No red flags. No prior management. Initial imaging. There is a lack of evidence supporting or refuting imaging early or before conservative treatment for TBP [3,20]. However, extrapolating from the low back pain (LBP) evidence, imaging is typically not warranted in this setting. Acute (<4 weeks duration), uncomplicated (no red flags) LBP with or without radiculopathy, is considered a self- limiting condition that is responsive to medical management and physical therapy in most patients [5-8]. Numerous studies have shown routine imaging provides no clinical benefit in this LBP group [6]. Thoracic disc disease is less common than in the cervical or lumbar spine [21]. This may be due to the fact that the thoracic spine is the only portion of the spine with additional structures (ie, ribs) to help in weight-bearing. There is also relatively limited mobility in the thoracic spine as the costovertebral joint limits flexion, the rib cage limits rotation and lateral bending, and the discs are relatively small in size compared to the cervical or lumbar spine. Symptomatic thoracic disc disease occurs most frequently below the level of T7. Thoracic disc abnormalities such as herniations, bulges, annular fissures, and cord contour deformity are common in asymptomatic patients [22].
Thoracic Back Pain. More than one procedure can be considered usually appropriate in the initial imaging evaluation when: The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org OR Discussion of Procedures by Variant Variant 1: Adult. Acute Thoracic back pain without myelopathy or radiculopathy. No red flags. No prior management. Initial imaging. There is a lack of evidence supporting or refuting imaging early or before conservative treatment for TBP [3,20]. However, extrapolating from the low back pain (LBP) evidence, imaging is typically not warranted in this setting. Acute (<4 weeks duration), uncomplicated (no red flags) LBP with or without radiculopathy, is considered a self- limiting condition that is responsive to medical management and physical therapy in most patients [5-8]. Numerous studies have shown routine imaging provides no clinical benefit in this LBP group [6]. Thoracic disc disease is less common than in the cervical or lumbar spine [21]. This may be due to the fact that the thoracic spine is the only portion of the spine with additional structures (ie, ribs) to help in weight-bearing. There is also relatively limited mobility in the thoracic spine as the costovertebral joint limits flexion, the rib cage limits rotation and lateral bending, and the discs are relatively small in size compared to the cervical or lumbar spine. Symptomatic thoracic disc disease occurs most frequently below the level of T7. Thoracic disc abnormalities such as herniations, bulges, annular fissures, and cord contour deformity are common in asymptomatic patients [22].