Orientation and general presentation (Fig. 4.1)

The spine consists of 33 vertebrae (7 cervical, 12 thoracic, 5 lumbar, 5 sacral fused into the sacrum, 4 coccygeal fused into the coccyx) (Fig. 4.1A,B). The only ‘easily’ palpable structures of the spine are the spinous processes of the vertebrae, except for the first cervical vertebra, which has no spinous process. (Palpation of the sacrum is described independently; see p. 104; palpation of the coccyx is not considered.)

Figure 4.1 The relationships of the spine, with the skull above and the sacrum below, are visible.

A Posterior view. B Lateral view. C Lateroposterior view of cervical vertebra. D Lateroposterior view of thoracic vertebra. E Lateroposterior view of lumbar vertebra. Note the morphologic differences in the spinous process at each level (see text for explanation).

The spinous process is the most posterior part of the vertebra, and points backwards. Spinous processes have various shapes and orientations, according to the level considered:

Spine – Spinous process (CV2–CV7, TV1–TV12, LV1–LV5)[M] ISB|Anim

The palpator sits behind the sitting subject.

First locate the external occipital protuberance (SOP, see p. 10).

From SOP, glide down vertically with your second finger towards the base of the skull, gently pushing into the soft tissue.

The first palpable spinous process in this area is CV2.

Place your second finger on CV2, and put the other fingers below one another.

In this position, the tip of your third, fourth and fifth fingers will be on CV3, CV4 and CV5 respectively, although actual palpation might be difficult (see note).

Mark these landmarks if you are able to palpate them well (see note).

Now, for each spinous process (illustrated here for CV6):

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