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Thoracic Radicular Pain

Thoracic radiculopathy presents an uncommon spinal disorder that can often be overlooked because numerous structures surround the thoracic spine. Radiculopathy typically originates from mechanical nerve root compression due to degenerative spine changes such as disc herniation, spondylosis, or osteoporosis and its associated vertebral compression fractures. The presentation of radicular pain in the thoracic region is more common in the upper thoracic and, with lateral disk herniations, often associated with some amount of axial pain. Clinical symptoms are leg weakness, numbness and tingling across the chest or abdomen or shoulders, spasticity, and bowel or bladder dysfunction. The vast majority of patients with thoracic pain return to their previous functional level without surgical intervention. Strengthening, postural optimization, and general exercise and mobility comprise the cornerstone of all treatment and prevention of thoracic radicular pain. Medication may include a variety of choices, ranging from NSAIDs to anticonvulsants. Medications to address specific health issues leading to thoracic radiculopathy (diabetes mellitus and osteoporosis) may be of additional benefit. Thoracic epidural injections or paravertebral blocks with corticosteroids and local anesthetics may be a treatment consideration. Surgical intervention is reserved for patients in whom conservative management has failed and who have persistent pain symptoms. Myelopathy is an indication for surgical intervention. Spinal cord stimulation may be effective to address chronic radiculopathy in selected patients.