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.
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.
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