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. 2016 Aug;6(4):358–368. doi: 10.1212/CPJ.0000000000000265

Figure 1. Lumbar spine anatomy.

Figure 1

(A) Ligaments of the lumbar spine: The supraspinous ligament connects the tips of the spinous processes, the interspinous ligament connects the shafts of the spinous processes, and the ligamentum flavum connects the lamina. The posterior longitudinal ligament is a dense band that stretches along the posterior aspect of the vertebral bodies. (B) Midline vs paramedian approach to lumbar puncture: Using a traditional midline approach, the spinal needle is inserted in the narrow space in between spinous processes, while in a paramedian approach, the spinal needle is inserted lateral to the spinous processes and angled toward the center of the spinal canal. (Reprinted with permission from Point-of-Care Ultrasound by Nilam J. Soni, Robert Arntfield, and Pierre Kory, ch. 35, pp. 283–284, Elsevier Health Sciences, 2014).