The spinous process is the posterior midline projection of each vertebra, serving as the attachment site for the supraspinous and interspinous ligaments and the erector spinae muscles. Spinous processes are palpable throughout the spine and are used as surface landmarks for spinal level identification. Their orientation varies by region — cervical processes are bifid, thoracic processes point sharply downward, and lumbar processes are horizontal.
Spinous process fractures (clay shoveler fractures) from sudden forced flexion produce a characteristically lower cervical or upper thoracic spinous process fracture from the supraspinous ligament avulsing the tip. They are stable injuries managed conservatively. Spinous process apophyses (secondary growth centres at the spinous process tips) can be confused with avulsion fractures on lateral spinal radiographs in adolescents.
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