The back is supported by 12 thoracic vertebrae (T1-T12) and five lumbar vertebrae (L1-L5). The lumbar vertebrae are larger and thicker than the cervical and thoracic vertebrae because they carry the most amount of body weight and are subject to the largest forces and stresses along the spine (see Fig. 31-5). The alignment of thoracolumbar vertebrae with their disk and ligament is similar to the cervical spine. The joints between the vertebrae, ligaments, and muscles of the back stabilize the vertebral column.

The major longitudinal ligaments connecting the vertebrae are the anterior and posterior ligaments (connect vertebral bodies), ligamentum flavum (between adjacent laminae), and supraspinous and interspinous ligaments (connect spinous processes). The anterior and posterior longitudinal ligaments and supraspinous ligament run along the entire length of the vertebral column and support the spine. The interspinous ligament and ligamentum flavum provide additional posterior stability to the spine (Fig. 31-10).

Intervertebral disks make up about one third of the length of the spine. The normal movements of thoracolumbar spine are forward flexion (by asking the patient to touch toes), extension, lateral bending, and symmetric rotation (Fig. 31-11

Anterior longitudinal ligament

Supraspinous ligament

Interspinous ligament


Ligamentum flavum

Articular capsule Cut surface of pedicle

Posterior longitudinal ligament

Intervertebral disc

Figure 31-10 Supporting ligaments of the spine. (Redrawn from Brinker MR, Miller MD. Fundamentals of Orthopedics. Philadelphia, Saunders, 1999, p 242.)

and Table 31-2). Flexion and extension are limited in the thoracic region because of the rib cage.

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