Morphological Characteristics of the Spinous Process of Axis: Clinical Implications for Cervical Spine Manipulation

Morphological analysis of C2–C7 spinous process bifurcation in Chinese population: a study using three-dimensional reconstruction of computed tomography

“…Lewit even advocated that the deviation of the SPs can be the source of neck pain [16]. The direction of SP deviation is thus vital for the adjustment of spine alignment with manual therapy [3,15]. However, we noticed that the asymmetry of bifurcation may have affected the results of SP palpation from the posterior neck region [5].…”

“…Previous works studying SPB often chose materials such as dry cervical bone specimens, plain films, CT, and MRI [1,[3][4][5][6][7]. Few used the reconstructed 3D model to study SPB.…”

“…SP is also an essential bony landmark in palpation of the cervical spine, commonly used by clinicians, manual therapists and chiropractic practitioners. In some theories, checking whether the SP is located in the posterior median position is a diagnosis procedure of cervical spine mal-alignment [3,15]. Lewit even advocated that the deviation of the SPs can be the source of neck pain [16].…”

“…Previous research on cervical spinous process bifurcation (SPB) has focused on its application in archeology, anthropology, and forensic medicine. Nevertheless, little literature discussed its importance in clinical medicine [1][2][3][4]. In clinical practice, the spinous process (SP) is generally used as an essential bony landmark for vertebral level determination, either by palpation or during open operation.…”

“…In clinical practice, the spinous process (SP) is generally used as an essential bony landmark for vertebral level determination, either by palpation or during open operation. SP bifurcation could alter the practitioner's judgment in level determination [3]. Previous research describes cervical SPB as a morphological feature that can be easily identified in C2 to C6 vertebrae, while nearly all C7 presents no bifurcation [5,6].…”