 Introduction/Background In the United States, spinal pain is one of the leading causes of disability, health care costs, and emergency room visits [1,2]. The lumbar and cervical spine regions have been extensively studied and have well-established associations with pain and disability. Comparatively, thoracic back pain (TBP) has received less attention in terms of genetic and epidemiological research [3]. However, the thoracic spine is a common site for inflammatory, neoplastic, metabolic, infectious, and degenerative conditions [3]. Therefore, TBP may be equally disabling and associated with significant morbidity. Uncomplicated acute TBP and/or radiculopathy may be a benign, self-limited condition that does not warrant any imaging studies [5-8]. Imaging may be considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. Imaging may also be considered for those patients presenting with red flags, raising suspicion for a serious underlying condition, such as symptomatic spinal canal stenosis, cord deformity or compression, malignancy, fracture, or infection [9,10]. For those patients with significant trauma, myelopathy, or prior thoracic spine fusion, early imaging may also be warranted [11-14]. Because the thoracic spine is a common site for osteoporotic compression fractures [15-17], early imaging should also be considered in patients with known osteoporosis or risk factors such as >65 years of age or chronic steroid use [18]. For those patients without neurologic compromise and who present with minor risk factors for cancer, inflammatory back disease (eg, ankylosing spondylitis), vertebral compression fracture, or symptomatic spinal stenosis, imaging may be considered after a trial of therapy. Initial Imaging Definition Initial imaging is defined as imaging at the beginning of the care episode for the medical condition defined by the variant.
Thoracic Back Pain.  Introduction/Background In the United States, spinal pain is one of the leading causes of disability, health care costs, and emergency room visits [1,2]. The lumbar and cervical spine regions have been extensively studied and have well-established associations with pain and disability. Comparatively, thoracic back pain (TBP) has received less attention in terms of genetic and epidemiological research [3]. However, the thoracic spine is a common site for inflammatory, neoplastic, metabolic, infectious, and degenerative conditions [3]. Therefore, TBP may be equally disabling and associated with significant morbidity. Uncomplicated acute TBP and/or radiculopathy may be a benign, self-limited condition that does not warrant any imaging studies [5-8]. Imaging may be considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. Imaging may also be considered for those patients presenting with red flags, raising suspicion for a serious underlying condition, such as symptomatic spinal canal stenosis, cord deformity or compression, malignancy, fracture, or infection [9,10]. For those patients with significant trauma, myelopathy, or prior thoracic spine fusion, early imaging may also be warranted [11-14]. Because the thoracic spine is a common site for osteoporotic compression fractures [15-17], early imaging should also be considered in patients with known osteoporosis or risk factors such as >65 years of age or chronic steroid use [18]. For those patients without neurologic compromise and who present with minor risk factors for cancer, inflammatory back disease (eg, ankylosing spondylitis), vertebral compression fracture, or symptomatic spinal stenosis, imaging may be considered after a trial of therapy. Initial Imaging Definition Initial imaging is defined as imaging at the beginning of the care episode for the medical condition defined by the variant.