Thoracic myelopathy is most commonly due to compressive etiologies, including structural causes resulting in spinal canal stenosis, cord compression/deformity, or other inflammatory, infectious, vascular, or neoplastic etiologies [28]. Spinal stenosis is a common cause of myelopathy, typically from disc herniations (including giant calcified disc herniations), usually below T7, facet arthropathy, or ligamentum flavum ossification [29]. Symptomatic thoracic disc herniations are more common in patients in their third to fifth decades of life and, in more than one-third of patients, are associated with a history of trauma. On imaging, these are often calcified (20%- 65%) and sometimes intradural (5%-10%) [30]. Patients with symptomatic thoracic disc herniations may have thoracic midback pain (76%), motor/sensory deficit (61%), spasticity/hyperreflexia (58%), positive Babinski sign (55%), or bladder dysfunction (24%). Symptomatic thoracic disc herniations requiring surgery are rare, accounting for 1% to 2% of all discectomies [31]. Indication for surgery is usually severe, intractable pain, or progressive/severe myelopathy. Thoracic radiculopathy is most commonly due to mechanical nerve root compression from degenerative, metabolic, infectious, or neoplastic causes. Bone Scan Whole Body There is no relevant literature to support the use of whole-body bone scans in the initial imaging of TBP and myelopathy or radiculopathy. Bone Scan with SPECT or SPECT/CT Thoracic Spine There is no relevant literature to support the use of bone scan with SPECT or SPECT/CT in the initial imaging of TBP and myelopathy or radiculopathy. CT Myelography Thoracic Spine CT myelography of the thoracic spine can be useful in assessing the patency of the spinal canal/thecal sac.
Thoracic Back Pain. Thoracic myelopathy is most commonly due to compressive etiologies, including structural causes resulting in spinal canal stenosis, cord compression/deformity, or other inflammatory, infectious, vascular, or neoplastic etiologies [28]. Spinal stenosis is a common cause of myelopathy, typically from disc herniations (including giant calcified disc herniations), usually below T7, facet arthropathy, or ligamentum flavum ossification [29]. Symptomatic thoracic disc herniations are more common in patients in their third to fifth decades of life and, in more than one-third of patients, are associated with a history of trauma. On imaging, these are often calcified (20%- 65%) and sometimes intradural (5%-10%) [30]. Patients with symptomatic thoracic disc herniations may have thoracic midback pain (76%), motor/sensory deficit (61%), spasticity/hyperreflexia (58%), positive Babinski sign (55%), or bladder dysfunction (24%). Symptomatic thoracic disc herniations requiring surgery are rare, accounting for 1% to 2% of all discectomies [31]. Indication for surgery is usually severe, intractable pain, or progressive/severe myelopathy. Thoracic radiculopathy is most commonly due to mechanical nerve root compression from degenerative, metabolic, infectious, or neoplastic causes. Bone Scan Whole Body There is no relevant literature to support the use of whole-body bone scans in the initial imaging of TBP and myelopathy or radiculopathy. Bone Scan with SPECT or SPECT/CT Thoracic Spine There is no relevant literature to support the use of bone scan with SPECT or SPECT/CT in the initial imaging of TBP and myelopathy or radiculopathy. CT Myelography Thoracic Spine CT myelography of the thoracic spine can be useful in assessing the patency of the spinal canal/thecal sac.