Thoracic Facet Joints and Intraarticular Injection of Biologics

Thoracic spine pain is less common than neck or low back pain but can be just as disabling. Multiple structures in the thoracic spine can transmit pain, leading to mid back and upper back pain, often radiating into the chest or abdominal wall. The diagnosis of thoracic pain can be challenging, and facet joint interventions are often used for diagnosis and treatment. Platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) are biologics showing promise in managing spinal pain, but their use in the thoracic spine is not studied. Radiological imaging is often inconclusive in identifying the source of thoracic pain. Thus, diagnostic anesthetic or provocative injections are commonly used for diagnosis. The anatomy of the thoracic spine and facet joints differs from the lumbar region, making interventions more complex. Various procedures, including intraarticular thoracic facet joint injections and medial branch blocks, are performed to diagnose and treat thoracic pain. Complications from these procedures are rare but can include dural puncture, pneumothorax, and infections. Overall, this chapter highlights the importance of understanding thoracic facet joint involvement in chronic upper and mid back pain and the potential use of biologics for management.