A few reliable surface points let examiners identify individual vertebrae by touch, a skill used in posture assessment, manual therapy, injections and spinal imaging. The usual references are C7 at the base of the neck, the root of the scapular spine at T3, the inferior angle of the scapula at T7, the tops of the iliac crests at L4 and the posterior superior iliac spines at S2. From any of these, spinous processes are counted up or down.
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Surface levels are approximate: palpation studies show examiners are often one segment off, scapular landmarks shift with arm position and posture, and the iliac crest line varies between L3 and L5. In the mid-thoracic spine the spinous processes slope steeply downward, so each tip lies over the body of the vertebra below. Transitional vertebrae and cervical ribs also change the count, so injections and surgery are confirmed with imaging.
Start at C7: with the neck bent forward it is usually the most prominent bump at the base of the neck. To confirm it, keep fingers on the two lowest bumps and ask the person to tip the head back; C6 slides forward and fades under your finger, while C7 stays. Count down from C7, using the scapular root (T3) and inferior angle (T7) as cross-checks. For the lower back, rest your hands on the tops of the iliac crests and bring your thumbs to the midline to land on L4 or the L4-L5 gap, then find the dimples over the PSIS at S2 and count back up to confirm.
Sacralisation of L5 or lumbarisation of S1 changes the number of mobile lumbar segments and is a common cause of counting errors.
A forward slip of one vertebra on the one below may be felt as a step between adjacent lumbar spinous processes.
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