Mid Back Pain (Thoracic Spine)

Mid back pain is less common than neck or lower back pain, but when it occurs, it's rarely dismissed. The thoracic spine is inherently stable, so significant pain here often signals a specific structural cause that needs investigation.

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Neurosurgeon

15+ Years

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5000+

Procedures Performed

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What Is Mid Back Pain (Thoracic Spine)

The thoracic spine (T1–T12) connects the cervical spine above to the lumbar spine below. Unlike the neck and lower back, it is reinforced by the rib cage, which limits mobility and makes disc herniation and instability less common here. This structural rigidity is protective, but it also means that when thoracic pain does develop, it tends to have a more specific, identifiable cause rather than general wear and strain.

Common sources include vertebral fractures (particularly in older patients with osteoporosis), disc herniations, postural deformity, and muscular strain. Referred pain from internal organs can mimic thoracic spine pain, making accurate diagnosis especially important in this region.

Mid back pain can sometimes be referred from the kidneys, lungs, aorta, or other visceral structures. A thorough clinical evaluation is essential to rule out non-spinal causes before assuming the spine is the source.

30 Minutes

Same Day Procedure

General Anesthesia

2-6 Weeks Recovery

Common Types of Neck Pain Conditions

Thoracic Herniated Disc

Also called "thoracic disc prolapse" and "thoracic disc extrusion."

Disc herniation in the thoracic spine is uncommon but can be serious. When the disc material compresses the thoracic spinal cord — not just a nerve root — the consequences can include leg weakness, numbness below the level of compression, and bowel or bladder dysfunction. Surgical intervention is more often required in the thoracic region than the cervical or lumbar because the spinal canal is narrower here, leaving less tolerance for compression.

Thoracic Compression Fracture

Also called "vertebral compression fracture" (VCF) and "osteoporotic fracture."

A collapse of a thoracic vertebral body is most commonly the result of osteoporosis, though also seen with trauma or metastatic bone disease. Typically causes acute, severe mid back pain, particularly with movement. Multiple fractures lead to progressive kyphosis (hunched posture) and height loss. Minimally invasive procedures such as kyphoplasty can stabilize the fracture and relieve pain significantly.

Kyphosis

Also called hyperkyphosis or Scheuermann's disease (in adolescents)

Abnormal forward curvature of the thoracic spine beyond the normal range (approximately 20–45 degrees). Can be postural, degenerative, or structural (as in Scheuermann's disease). Mild kyphosis is managed with physical therapy and postural correction. Severe or progressive kyphosis — particularly if causing cord compression, pain, or functional limitation — may require surgical correction.

Thoracic Muscle Strain

Also called: thoracic sprain, mid back strain

Injury or overuse of the paraspinal muscles and ligaments of the midback. Common after heavy lifting, sudden twisting movements, or sustained poor posture. Usually self-limiting, resolving with activity modification, physical therapy, and anti-inflammatory treatment. Persistent mid back pain beyond 6 weeks, or pain without a clear mechanical cause, warrants further investigation to exclude structural pathology.

Thoracic Spinal Stenosis

Also called "thoracic canal stenosis"

Narrowing of the spinal canal in the thoracic region. Less common than cervical or lumbar stenosis, but potentially more consequential because cord compression in this region (myelopathy) can cause progressive loss of function in the legs. Typically caused by bone spurs, thickened ligaments, or disc bulging. Surgical decompression is often necessary to prevent permanent neurological damage.

Common symptoms

Localized mid back pain

Aching or sharp pain between the shoulder blades or along the thoracic vertebrae

Pain with breathing

Deep breaths or coughing worsens pain, particularly with rib involvement or compression fracture

Band-like chest pain

Pain that wraps around the torso is a sign of nerve root compression (thoracic radiculopathy)

Postural change

Progressive rounding of the upper back or visible height loss associated with kyphosis or fracture

Leg weakness or dysfunction

Thoracic cord compression can cause lower extremity symptoms a surgical emergency

Pain worse with sitting or flexion

Disc-mediated pain typically increases with forward bending or prolonged sitting

How we diagnose thoracic spine conditions

Thoracic diagnosis requires ruling out non-spinal causes first, then identifying the structural source within the spine. Imaging alone is insufficient; clinical correlation is essential.

Clinical examination

Neurological assessment of lower extremity function, reflexes, and sensation to detect cord involvement

MRI (thoracic spine)

Essential for visualizing the cord, disc herniations, ligament thickening, and tumors

CT scan

Detailed bone assessment, fracture characterization, canal dimensions, and surgical planning

DEXA scan

Bone density measurement essential context for fracture patients and osteoporosis management

X-ray (standing)

First-line for fracture, alignment, and measuring kyphotic deformity under load

Workup for non-spinal causes

Lab work or imaging to exclude renal, cardiac, or pulmonary referred pain when history warrants

Learn More

Seek urgent evaluation for these symptoms

Leg weakness, heaviness, or instability

Band-like chest tightness with neurological symptoms

Mid back pain with unexplained weight loss or fever

Bowel or bladder dysfunction

Sudden severe mid back pain after minor movement (fracture)

History of cancer with new spinal pain

Treatment Options

Treatment in the thoracic spine is more specific than in the cervical or lumbar regions. The relatively uncommon nature of thoracic pathology means the conditions that do occur often require targeted management, including surgical intervention, at a higher rate than lower back conditions.

Non-surgical

Physical therapy and postural rehab

Core strengthening, thoracic mobility work, and postural correction primary treatment for muscle strain and mild kyphosis

Thoracic epidural steroid injection

For nerve root irritation or disc-related thoracic radiculopathy

Thoracic facet joint injection

Diagnostic and therapeutic for facet-mediated mid back pain

Osteoporosis management

Bisphosphonates, calcium/vitamin D supplementation, and fall prevention to reduce fracture recurrence risk

Surgical

Kyphoplasty / vertebroplasty

Minimally invasive stabilization of compression fractures — cement injected into the collapsed vertebra to restore height and relieve pain

Thoracic discectomy / decompression

Removal of herniated disc material compressing the cord: the approach varies based on disc location and extent of compression

Thoracic spinal fusion

For instability, deformity correction, or following decompression when structural support is needed

Mid back pain that doesn't fit a pattern needs investigation.

We'll establish whether the cause is structural and what to do about it.

Request Appointment

(571) 399 6340

What to expect week by week

Recovery varies, but here's how most patients progress.

Same Day

Go home. Rest.

Procedure done. Mild soreness at the injection site is normal. Skip driving — you'll need a ride.

24–48 Hours

Soreness fades.

Site soreness clears in a day or two. Some patients notice early pain improvement starting here.

1 Week

You should feel a difference.

Most patients see a meaningful reduction in neck and arm pain as the steroid reaches full effect.

Weeks–Months

Continued improvement.

Relief can last weeks to months. A second injection or PT can extend it further if needed.

Expert Spine Surgeon

Dr. Avery L. Buchholz is a board-certified neurosurgeon with fellowship training in complex spine surgery. With over 15 years of experience and 5,000+ procedures performed, he specializes in both minimally invasive and complex surgical techniques.

His expertise spans the full spectrum of spine care, from non-surgical interventions to advanced reconstructive procedures, always prioritizing patient safety and optimal outcomes.

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About Dr. Buchholz

Frequently Asked Questions

Get answers to common questions about our practice and procedures

Why is mid back pain less common than neck or lower back pain?

The rib cage braces the thoracic spine, limiting movement and protecting it from typical wear and tear. So when pain does occur here, it usually points to a specific cause.

What usually causes mid back pain?

Common causes include muscle strain, compression fractures, disc herniation, and kyphosis. Stenosis is a rarer cause.

Can mid back pain come from somewhere other than the spine?

Yes, it can be referred from the kidneys, lungs, aorta, or other organs. That's why a full evaluation is needed before assuming the spine is the cause.

What symptoms suggest something serious?

Band-like pain around the torso, pain with breathing, postural changes, or leg weakness are red flags. Leg weakness especially needs urgent attention.