- 1 Neck landmarks
- 2 Thoracic spine landmarks
- 3 Lumbar spine landmarks
- 4 References
Inion (external occipital protuberance) is on the midline and a useful start point.
First cervical vertebra
C1 has the largest transverse processes. Palpating from behind in sitting, with the head slightly tilted back, they can be felt midway between the angle of the mandible and the mastoid. In this space you can feel the transverse processes as hard lumps, especially when the head turns.
Second cervical vertebra
C2 (axis) moving inferiorly from the inion, C2 is the first spinous process. C1 (atlas) does not have a spinous process.
Third to fifth cervical vertebrae
C3-5 spinous processes can be bifid.
Sixth cervical vertebra
C6 disappears under your finger on hyperextension/tilting the head back.
Seventh cervical vertebra
C7 75% of the time it is the most prominent. Running you hand inferiorly down the neck (in supine it is usually clearer) the first big bump you feel is usually C7. This is a very useful landmark. C7 is the superior bone of the CTJ (Cervical Thoracic Junction).
First thoracic vertebra
T1 25% of the time it is the most prominent, it does not rotate as much as C7 when the head turns.
Hyoid C3 level, Thyroid cartilage C4-5, First cricoid ring C6
Thoracic spine landmarks
Second thoracic vertebra
T2 superior angle of scapula.
Sixth and seventh thoracic vertebrae
T6/T7 inferior angle of scapula.
Twelfth thoracic vertebra
T12 is the first blade-like spinous process (same as the lumbars). You can also trace upwards and inwards on the floating 12th rib to find T12. T12 is the superior bone of the TLJ (Thoracic Lumbar Junction).
Xiphoid process of the sternum is at the level of T9.
Lumbar spine landmarks
Fourth lumbar vertebra
L4 spinous is at the level of iliac crests. This is an extremely useful landmark. You can find the iliac crests by placing the sides of your forefinger/hand in the fleshy part of the waist at the level of the umbilicus. Move inferiorly and the first hard lumps you feel on each side are the iliac crests.
Fifth lumbar vertebra
The easiest way is to count down from L4, find the next spinous process inferior to L4 and then move lateral and press down towards the feet. If you can feel the top of the sacrum you are at L5. L5 is the superior bone of the LSJ (Lumbar Sacral Junction)
Umbilicus is at the level of L3.