The twelve thoracic vertebrae form the posterolateral thoracic cage, each with a heart-shaped body, bilateral facets for rib articulation (costovertebral joints at the body and costotransverse joints at the transverse process), and long inferiorly-directed spinous processes. Their coronal facet orientation allows rotation (the primary thoracic motion, up to 35 degrees each side) while limiting sagittal flexion-extension. T4 is at the level of the sternal angle; T10 at the xiphoid.
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| Ossification | Each thoracic vertebra ossifies from three primary centres (body and two neural arches) fusing in childhood. Ring epiphyses appear at puberty and fuse at 25 years. |
Thoracic vertebral fractures from osteoporosis (compression fractures), trauma (burst fractures), and metastatic disease are managed based on neurological status and stability. Vertebroplasty and kyphoplasty inject cement into osteoporotic compression fractures, kyphoplasty uses a balloon to restore height before cement injection. Thoracic pedicle screw fixation is technically demanding due to the small pedicle diameter and proximity to the spinal cord.
Wedge fractures of the thoracic bodies cause back pain, height loss, and kyphosis.
The T11-L2 junction is the most common site of spinal fracture after high-energy trauma.
Wedging of adjacent thoracic vertebrae in adolescence produces a rigid round back.
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