The transverse processes of the atlas are the largest in the cervical spine, projecting further laterally than at any other cervical level. Each contains a transverse foramen through which the vertebral artery passes. The anterior and posterior tubercles of the transverse process provide attachment for several muscles and the anterior atlantoaxial ligament.
The atlas transverse process tip is the most lateral palpable point in the suboccipital region, identifiable between the mastoid process and the posterior mandibular angle. It is the target for C1 nerve root injection and atlantoaxial joint injection performed via lateral or posterior approach. The transverse process may fracture in high-energy cervical trauma. The vertebral artery is immediately adjacent and at risk during C1 lateral mass screw placement.
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