C7 is the vertebra prominens, named for its long, non-bifid spinous process that forms the most prominent posterior midline prominence at the cervicothoracic junction. It is the last cervical vertebra, transitioning between the mobile cervical spine and the relatively fixed thoracic spine. Its transverse foramina are typically smaller than C1-C6 and often transmit accessory vertebral veins rather than the vertebral artery.
C7 is the primary surface landmark for counting cervical vertebral levels. A cervical rib arises from the C7 transverse process in 0.5-1% of the population, potentially compressing the brachial plexus and subclavian vessels (neurogenic and vascular thoracic outlet syndrome). The C7-T1 level is the most commonly injured cervical disc level in athletes. Posterior cervical instrumentation identifies C7 as the anchor point for the cervicothoracic junction.
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