Thoracic spine evaluation

The thoracic spine should be evaluated for regional restrictions to motion. Because of the length of this region—12 vertebrae—it is helpful to divide the region into three segments upper thoracic spine (T1-T4), mid-thoracic spine (T5-T8), and lower thoracic spine (T9-T12). 

The lumbar spine consists of five vertebrae, the largest in size is the spinal column. Most congenital anomalies occur to the fifth lumbar vertebra. Both the thoracic spine and the sacrum and pelvis have significant effects on the posture and function of the lumbar spine. When performing an evaluation of the lumbar spine, it is necessary to include these areas in the examination. 

Gross motion of the lumbar spine is generally evaluated in conjunction with that of the thoracic spine. The patient is standing with his weight evenly distributed and his two feet are spaced 4 to 6 inches apart. The physician kneels or squats directly behind the patient his eyes are level with the lumbar spine. 

Wh.6n evaluating a patient for an exercise program of the thoracic cage, it is important to consider including exercises for the thoracic spine... 

Somatic dysfunction of the thorax may occur anteriorly, involving ribs, sternum, or clavicle, or posteriorly, involving costovertebral articulations or the scapulae. Muscle attachments connect the thoracic cage to the cervical spine, the thoracic spine, the lumbar spine, the innominate bones, and the upper extremities. These regions must be evaluated when problems occur in the thoracic cage. 

All patients with a history of shoulder problems must be evaluated for dysfunctions of the cervical spine, upper thoracic spine, sternum and upper ribs. 

Some further future goals are to include other areas of the spine, e.g., thoracic and cervical regions. We are also working on a finite element-compensation model for pre-op planing to estimate post-op changes and therefore allow a qualitative evaluation of the clinical concepts in this field. 

To date, the mechanical properties of the metastatic spine and the mechanisms of collapse have not been fuUy elucidated. Moreover, the correlation between vertebral body coUapse and the location and extent of the metastatic tumor is not fully understood. Taneichi et al. (1997) evaluated 100 thoracic and lumbar vertebrae (53 patients) with osteolytic lesions, determined risk factors for vertebral coUapse, and estimated the probability of coUapse under various states of metastatic vertebral involvement. The most important risk factor leading to vertebral coUapse in the thoracic region was involvement of the costovertebral joint. Tumor size within the vertebral body was the second most important risk factor. In-... 

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