The spinalis is the medial column of the erector spinae, attaching to the spinous processes of the upper lumbar and lower thoracic vertebrae. Its short tendinous insertions blend with those of semispinalis thoracis and multifidus, forming a complex interconnected midline extensor mechanism.
The spinalis tendon is rarely injured in isolation but contributes to midline posterior lumbar pain in chronic erector spinae syndromes. Tenderness directly over the spinous processes may indicate spinous process apophysitis, supraspinous ligament pathology, or spinalis tendon involvement. MRI differentiates these overlapping diagnoses.
Midline posterior lumbar pain from spinous process traction at the spinalis insertion, reproduced by trunk extension and distinguished from supraspinous ligament pathology by depth of tenderness.
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