Degenerative changes in the spine, which can be seen on MRI scans, are often included in the diagnostic assessment of back pain, but their clinical significance is not always clear. In the cervical and lumbar spine, these changes have been relatively well studied, with research consistently demonstrating a moderate but stable correlation between pain and various types of degenerative changes, such as disc degeneration, disc herniation, and endplate changes. In contrast, research on degenerative changes in the thoracic spine is limited.
Researchers from the University of Southern Denmark (SDU) and the Chiropractic Knowledge Hub have reviewed existing studies to examine how frequently these changes occur in the thoracic spine and whether they are associated with back pain and functional impairment.
The researchers conducted a systematic review of medical databases to identify relevant studies. They found 23 articles on the topic, which included data from 20 different study populations. The studies were analyzed to determine data quality and the risk of bias. Due to methodological differences between the studies, the researchers could not perform a meta-analysis, so the results were described individually.
How Common Are Degenerative Changes?
The prevalence of degenerative changes in the thoracic spine was reported in 21 articles, of which only five were assessed to have a low risk of bias. The reported prevalence varied significantly across studies. For instance, disc degeneration was reported in 0.2% to 89% of cases, and endplate changes in vertebrae ranged from 0% to 82%, depending on the population and imaging method used.
Is There a Link Between These Changes and Pain?
Only four studies examined a possible association between MRI findings and pain in the thoracic spine. The risk of bias in these studies was assessed as either low or unclear. Two of the studies found a weak association between certain changes and pain, while the other two found no correlation. None of the studies investigated the relationship between degenerative changes and functional impairment.
What Does This Mean for Patients and Clinicians?
The significant variations in study results and methods mean that no definitive conclusions can be drawn about the prevalence of degenerative changes in the thoracic spine or whether they cause pain. For clinicians, this suggests that MRI findings in the thoracic spine should be interpreted with caution and should not be used in isolation to explain a patient’s pain.
There is a clear need for more standardized studies that systematically investigate how these changes affect pain and functional levels. Until then, clinicians should continue to base their assessments on a combination of medical history, clinical findings, and imaging rather than placing too much emphasis on degenerative findings on MRI.
Bodil Al-Mashhadi Arnbak, Stine Haugaard Clausen, Mette Jensen Stochkendahl, Rikke Krüger Jensen. Prevalence of thoracic degenerative MRI findings and association with pain and disability: a systematic review. Skeletal Radiology 2025