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.
| Articulations |
|
|---|---|
| Landmarks |
|
| Ossification | Spinous processes ossify from the primary vertebral arch centres, with secondary apophyses appearing at the tips during adolescence and fusing by age 25. |
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.
Ask the person to bend forward slightly to separate the vertebrae. Run your fingertips down the midline of the back: each firm bump is a spinous process and the soft gaps between them are the interspinous spaces. Use C7 at the base of the neck or the iliac crest line (L4) as a starting point for counting.
Avulsion or direct blow fractures, classically the clay-shoveler's fracture at C7 or T1, which are usually stable.
Contact between adjacent lumbar spinous processes with hyperlordosis causes midline back pain worse on extension.
This website uses cookies to enhance your experience. Some are essential for site functionality, while others help us analyze and improve your usage experience. Please review your options and make your choice.
If you are under 16 years old, please ensure that you have received consent from your parent or guardian for any non-essential cookies.
Your privacy is important to us. You can adjust your cookie settings at any time. For more information about how we use data, please read our privacy policy. You may change your preferences at any time by clicking on the settings button below.
Note that if you choose to disable some types of cookies, it may impact your experience of the site and the services we are able to offer.
Some required resources have been blocked, which can affect third-party services and may cause the site to not function properly.
This website uses cookies to enhance your browsing experience and ensure the site functions properly. By continuing to use this site, you acknowledge and accept our use of cookies.
