What do the radiographic findings of a slight leftward thoracic curve (likely positional), preserved vertebral body height, osteophyte formation and disc space narrowing in the mid‑ and lower thoracic and cervical spine, reversal of cervical lordosis, and preserved costovertebral junctions—indicating thoracic and cervical spondylosis—mean?

Interpretation of Your Thoracic and Cervical Spine Radiographs

What These Findings Mean

Your radiographs show age-related degenerative changes (spondylosis) in both your thoracic (mid-back) and cervical (neck) spine, which are extremely common findings that do not necessarily correlate with pain or require treatment unless you have specific neurological symptoms. 1

Breaking Down Each Finding

The Slight Leftward Thoracic Curve

• This mild curvature is likely positional (meaning it's related to how you were positioned during the X-ray) and is not a structural deformity 1
• Since vertebral body height is preserved, there is no evidence of compression fractures or significant structural damage 2, 3

Spurring and Disc Height Narrowing (Spondylosis)

• Osteophytes (bone spurs) and disc space narrowing represent normal wear-and-tear changes that accumulate with age 4, 5
• These changes are found in the mid and lower thoracic levels (typically T6-T12) and mid and lower cervical levels, which are the most common locations for degenerative changes 2, 4
• Critical point: Thoracic disc abnormalities such as herniations, bulges, and degenerative changes are commonly seen in people without any back pain, meaning these findings on imaging do not automatically explain symptoms 1
• Similarly, morphologic changes of osteoarthritis in the spine do not correlate with pain 1

Reversal of Cervical Lordosis

• The normal cervical spine has a gentle forward curve (lordosis) 6, 7
• Reversal of this curve can be due to muscle spasm, positioning during the X-ray, or chronic degenerative changes 6
• This finding alone does not indicate a serious problem and is commonly seen 7

Preserved Costovertebral Junctions

• This is a reassuring finding indicating that the joints where your ribs attach to your thoracic spine are intact 2, 3
• No evidence of inflammatory arthritis or destructive processes 1

Clinical Significance and What Matters Most

When These Findings Are Clinically Important

These radiographic findings only become clinically significant if you have specific symptoms, particularly neurological symptoms 6, 7:

• Red flag symptoms requiring urgent evaluation include:
  • Progressive weakness in arms or legs 6, 7
  • Bilateral arm AND leg symptoms (suggesting spinal cord compression) 6, 7
  • New bladder or bowel dysfunction 6, 7
  • Loss of sensation in the groin/perineal area 6, 7
  • Difficulty walking or with fine motor tasks 6

When These Findings Are NOT Clinically Important

• If you have only mechanical back or neck pain without arm/leg radiation, these imaging findings do not change management and imaging was likely unnecessary 1
• Approximately 75-90% of patients with neck pain improve with conservative treatment regardless of imaging findings 6, 7
• The presence of spondylosis on imaging does not predict who will or will not respond to conservative care 1, 4

What Happens Next: Management Algorithm

If You Have NO Radicular Symptoms (No Arm/Leg Pain or Numbness)

• Conservative management is appropriate: physical therapy, NSAIDs or acetaminophen for pain control, and activity modification 6
• Most cases resolve within 6-12 weeks 6, 7
• Epidural steroid injections are NOT indicated for non-radicular back pain 8

If You Have Radicular Symptoms (Arm Pain, Numbness, Tingling)

• MRI without contrast is the appropriate next imaging study if symptoms persist beyond 4-6 weeks of conservative treatment 6, 7
• Continue conservative management for 6-12 weeks unless red flag symptoms develop 6, 7
• Consider short course of oral corticosteroids for acute severe radicular pain 6

If You Have Red Flag Symptoms

• Immediate MRI and possible surgical consultation are warranted 6, 7
• Do not delay imaging or treatment 6

Important Caveats

• Cervical and thoracic spondylosis frequently coexist: patients with thoracic spinal deformity have a 3.27 times higher likelihood of having cervical spondylosis 9
• Symptomatic thoracic spondylosis is uncommon compared to cervical or lumbar spondylosis, and when it does cause symptoms, it most commonly affects levels T10-T12 2, 3
• Even patients with long-standing thoracic spondylosis and severely impaired function have a good prognosis for at least partial recovery with appropriate treatment 2
• Approximately 30-50% of patients may have residual or recurrent symptoms up to 1 year, but most achieve symptomatic relief 6, 7