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Transverse processes

The transverse processes are paired, lateral bony projections extending from the junction of the pedicle and lamina of a vertebra. Present along the cervical, thoracic, lumbar, sacral, and coccygeal vertebrae, their morphology varies by spinal region but they consistently serve as attachment points for muscles and ligaments and articulate with ribs in the thoracic spine.

In the cervical spine, the transverse processes contain the foramina transversaria, which transmit the vertebral artery and vein (except C7, which usually transmits only the vein). In the thoracic spine, they articulate with tubercles of ribs via costotransverse joints. In the lumbar spine, they are long and thin, serving as strong levers for back muscles. In the sacrum, they are fused to form the lateral sacral crest.

Clinically, transverse processes are important in spinal stabilization, trauma assessment, and surgical landmarking. Fractures of the transverse processes often indicate high-energy trauma.

Synonyms

  • Processus transversus

  • Lateral vertebral process

Function

  • Provide attachment sites for muscles: erector spinae, multifidus, rotatores, levator costarum, quadratus lumborum, intertransversarii

  • Provide attachment for ligaments such as intertransverse ligaments

  • In thoracic vertebrae, articulate with rib tubercles (costotransverse joints)

  • Serve as levers to increase mechanical advantage for spinal muscles

  • Important surgical and radiological landmarks

Nerve Supply

  • Muscles attached to transverse processes are innervated by dorsal rami of spinal nerves in their respective regions

Arterial Supply

  • Cervical: vertebral and ascending cervical arteries

  • Thoracic: posterior intercostal arteries

  • Lumbar: lumbar arteries

  • Sacral: lateral sacral arteries

Venous Drainage

  • Mirrors arterial supply, draining into vertebral venous plexuses, azygos system (thoracic), lumbar veins, and sacral venous plexuses

MRI Appearance

T1-weighted images:

  • Cortical bone: low signal intensity

  • Marrow of transverse process: intermediate signal

  • Surrounding muscle attachments clearly distinguished

T2-weighted images:

  • Cortex: low signal

  • Marrow: variable, often intermediate

  • Edema or fracture: bright hyperintense signal within marrow

STIR:

  • Suppresses fat, making bone marrow edema, fractures, or inflammatory changes appear hyperintense

  • Sensitive for detecting stress fractures and metastasis

T1 Fat-Saturated (Pre-contrast):

  • Marrow: intermediate signal

  • Enhances contrast between marrow and surrounding fat planes

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Normal marrow enhances mildly

  • Pathologies such as infection, metastases, or inflammation show strong, often heterogeneous enhancement

MRI 3D Reconstructions:

  • Provide detailed visualization of transverse process alignment and muscle attachment relationships

  • Useful in preoperative surgical mapping

CT Appearance

CT Pre-Contrast:

  • Transverse processes seen as high-attenuation cortical bone with trabecular marrow core

  • Best for detecting fractures, sclerosis, or congenital anomalies

CT Post-Contrast:

  • Bone itself does not enhance, but adjacent soft tissue enhancement may reveal infection, tumor infiltration, or hematoma

  • Provides excellent bony detail for trauma and surgical planning

  • 3D CT reconstructions demonstrate alignment and fracture morphology

CT image

transverse processes of vertebrae ct axial image

CT VRT 3D image

transverse processes of vertebrae ct 3d image

MRI image

transverse processes MRI axial anatomy image -img-00000-00000

MRI image

transverse processes MRI SAG anatomy image -img-00000-00000

X Ray image

X ray Transverse process