In the pain clinic, we often encounter patients with intractable thoracic back (and sometimes upper abdominal) pain, and after laboratory tests, especially x-rays, other diseases are ruled out and confirmed to be due to compression fractures of the thoracic spine. Many patients have seen several hospitals before that, taken multiple treatments and countless drugs, with poor results. Therefore, we would like to introduce to you our treatment for this type of disease. First, we will introduce 2 typical cases. Case 1: A 78-year-old male, previously in good health, came to our hospital because he felt sudden back pain while carrying grain 2 days ago, and gradually developed paroxysmal radiating severe pain in the left chest, unable to lie down and sleep at night, and oral pain medication was ineffective. After X-ray and CT examination, he was found to have generalized osteoporosis and degeneration of the vertebrae of the spine, including compression fractures of the 9th and 10th vertebrae of the thorax, with 2/3 of the vertebral body compressed in a wedge-shaped vertebral body. The pain disappeared after transfer to orthopedics for myeloplasty and healed and was discharged. Case 2: Female, 82 years old, presented to the hospital with persistent back and right-sided chest pain for six months, with no obvious history of previous trauma. On X-ray and CT examination, a compression fracture of the 7th and 8th vertebrae of the chest was found, with 2/3 of the vertebrae compressed and wedge-shaped changes. The patient had a previous history of hypertension, cerebral infarction and diabetes mellitus, and surgical treatment was risky and refused by the patient and family. We treated the patient with intralesional injections once a week, and after 3 sessions the patient’s symptoms almost completely disappeared. So let’s talk more about why the elderly are prone to thoracolumbar compression fractures? The etiology of osteoporosis in the elderly is complex, such as hypogonadism, reduced exercise, imbalance of calcium-regulating hormones and various other risk factors (e.g., vitamin D deficiency). According to the literature, osteoporosis can occur in men after 50 years of age and in women after 40 years of age to varying degrees, and it will become more serious with age, and many diseases such as diabetes, rheumatism, tumors, malnutrition, abnormal adrenocortical function, hyperthyroidism, etc. can aggravate osteoporosis. Compression deformation of the cone occurs when the osteoporosis reaches a certain level and can occur in daily life (so many patients do not have an obvious history of trauma), especially when bending over and bearing weight. Why does thoracic back pain occur after a thoracolumbar compression fracture? The average patient with vertebral compression does not have obvious symptoms, but only when the vertebrae are compressed to a certain degree and compress the spinal nerve roots will cause back pain that radiates along the back into the chest or upper abdomen. This pain is often not caused by direct mechanical compression of the nerve roots, but by aseptic inflammation of the thoracic vertebral body compression site that irritates the nerve roots or by ischemia of the nerve roots due to stenosis of the intervertebral foramen. What is the manifestation of thoracic back pain after thoracolumbar compression fracture? Elderly people (more than 60 years old, women are more common) complained of sudden onset of severe pain in the thoracic back after bending over to do light housework or minor trauma to the low back, chest pain is mostly unilateral, and some patients can radiate along the intercostal area to the abdomen. The pain is slightly relieved after resting, but it is significantly increased with a little activity, even when bending over or turning over in bed, the pain is very intense, and in some cases the pain is unbearable even when inhaling deeply, talking loudly, coughing or sneezing. On examination, these patients are found to have scoliosis or “hunchback”, and the lower thoracic and upper lumbar vertebrae often protrude backward, with some localized pressure pain. A frontal and lateral X-ray or CT examination of the thoracolumbar vertebrae can be seen to be compressed into a wedge shape, which is typical of a compression fracture of the thoracolumbar spine caused by osteoporosis. How to treat thoracic back pain after thoracolumbar compression fracture? In terms of osteoporosis itself, treatment measures should be comprehensive. For example, appropriate sports, increase outdoor activities, calcium supplements, vitamin D to increase calcium intake, reasonable diet, etc. However, if there is persistent chest and back pain, the conservative treatment mentioned above will not be effective, and pain medication is not a cure. Therefore, at present, the two main methods are surgery and intraspinal injection. The traditional method of internal fixation surgery is no longer used due to the high trauma and complications. The new surgical method is minimally invasive surgery – cemented vertebroplasty, in which the vertebral body is shaped with the Sky Expandable Vertebroplasty System and then injected with bone cement, which is more effective at an earlier stage but less effective for old thoracic compression fractures. There are also many patients who are not suitable for surgery due to their age and many medical comorbidities, and some patients refuse surgery due to financial reasons or fear of surgery, then intradural injection therapy is used. This method involves puncturing the epidural cavity at the fracture site with a specially designed fine puncture needle and injecting drugs to eliminate local sterile sexual verification and a small amount of local anesthetic drugs once a week for a course of 3 to 4 times, which is effective and not easily recurring. The disadvantage is that the puncture is difficult and must be done by an experienced pain physician.