C7, the vertebra prominens, has the longest spinous process of all cervical vertebrae and is palpable as the prominent bony prominence at the base of the neck, making it a key surface landmark for counting vertebral levels. As the last cervical vertebra, it marks the transition from the mobile cervical spine to the stiffer thoracic spine.
| Articulations |
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|---|---|
| Landmarks |
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| Ossification | As per cervical vertebra pattern, with the vertebra prominens spinous process tip sometimes having a separate ossification centre. |
C7 is known as the vertebra prominens because its long non-bifid spinous process is the most prominent bony landmark at the base of the neck and used for counting vertebral levels. C6-C7 disc herniation produces C7 radiculopathy with triceps weakness, diminished triceps reflex, and middle finger numbness. The transverse foramina of C7 do not usually transmit the vertebral arteries (they enter at C6). A cervical rib arising from C7 in about 0.5 to 1 percent of people can cause neurogenic or vascular thoracic outlet syndrome. C7 is also an important anchor level in posterior instrumentation across the cervicothoracic junction.
Ask the person to bend the head forward and feel at the base of the neck for the most prominent midline bump. To confirm it is C7, keep a finger on it and one on the bump above, then have the person tip the head back: C6 slides forward and fades under your finger while C7 stays in place. T1, just below, moves even less with neck rotation.
A stable avulsion fracture of the C7 (or T1) spinous process caused by sudden pull of the trapezius and rhomboids or by direct flexion.
An elongated C7 transverse process or cervical rib can compress the brachial plexus or subclavian artery, causing arm pain, paraesthesia, or vascular symptoms.
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