Upper Back (Thoracic Spine) X-ray (3 views)

What it is

The thoracic spine is the stiff middle section of the back, anchored by the ribcage, and it behaves differently from the flexible neck and lower back above and below it. Because it is braced, it does not usually wear out the way the lumbar spine does — but it is where the vertebrae most often collapse under their own load when bone has thinned. A three-view series gives the radiologist a front view, a side view, and a third angle. The side view is the one that does most of the work here: it shows the height of each vertebral body in profile, so a wedge-shaped one that has lost height stands out against its neighbours, and it shows the front-to-back curve of the whole section.

Why it is done

• To look for a compression fracture in the mid back, particularly after a fall or in someone with thinning bone
• To investigate mid-back pain that has not settled
• To assess curvature of the spine and measure how it is changing over time
• To look for arthritic change, bone spurs, or narrowing between vertebrae
• To look at the bone itself when a tumor or an infection is being considered

What to expect

Clothing with metal fasteners comes off and most people change into a gown. Some views are taken lying on the table and some standing against an upright plate, depending on what is being measured — a curve is normally assessed standing, since that is when it is loaded. You will be asked to hold a breath for each exposure so the ribs and diaphragm stop moving. Each one takes a second or two, and the series is usually finished within ten minutes. Worth knowing: an X-ray shows bone, so it will not show a disc pressing on a nerve, a muscle strain or the spinal cord itself. If those are the question, an MRI or CT is what answers it.

Questions worth asking

• Was a three-view series ordered, or two? The number of views changes the code and the price.
• If the real question is nerve or disc trouble, is an X-ray a useful first step here or will an MRI be needed anyway?
• If this is to monitor a curve or a healed fracture over years, can the repeats be done at a lower-cost outpatient center?
• Does the quoted price include the radiologist's report?