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Cervical Vertebrae

Vertebrae cervicales

For medical students3 min readUpdated 2026-10-10

Cervical vertebrae are the seven upper bony segments of the human vertebral column. They share an important common feature: the presence of a foramen within each transverse process, which serves as a passage for blood vessels.

Total countSeven vertebrae (designated C₁–C₇)
Main featurePresence of the transverse foramen (foramen transversarium)
Special tubercleCarotid tubercle located on the sixth cervical vertebra
C₇ vesselsOnly veins pass through the transverse foramina of the seventh vertebra

General Features of Cervical Vertebrae

All cervical vertebrae (vertebrae cervicales) share several unique characteristics that distinguish them from vertebrae in other regions. The most critical feature is the transverse foramen (foramen transversarium). It is formed by the fusion of the true transverse process (processus transversus) and a rudimentary cervical rib (rudimentum costae). This foramen is clearly bounded by bone both anteriorly and posteriorly.

Along the transverse process runs the sulcus for the spinal nerve (sulcus nervi spinalis), located between the rib rudiment and the process. The margins of the transverse process terminate in two projections: the anterior and posterior tubercles (tuberculum anterius et posterius). The sixth cervical vertebra (C₆) is an exception: its anterior tubercle is significantly larger than the others and is termed the carotid tubercle (tuberculum caroticum). It received this name because the common carotid artery lies directly adjacent to it.

Other typical features of cervical vertebrae include:

Atlas (C₁): First Cervical Vertebra

The first cervical vertebra is called the atlas (atlas). It is a completely atypical vertebra, lacking both a body (corpus) and a spinous process (processus spinosus). Its structure consists of two lateral masses (massae laterales) connected by anterior and posterior arches.

Important articular surfaces are located on the lateral masses:

  1. Superior articular surface (facies articularis superior) — oval, deep, and concave, designed to articulate with the occipital condyles (condyli occipitales).
  2. Inferior articular surface (facies articularis inferior) — flatter and rounder, designed for articulation with the second cervical vertebra.

The anterior arch (arcus anterior atlantis) features the fovea for the dens (fovea dentis) on its inner surface, which receives the dens of the axis below. Externally, this arch bears the anterior tubercle.

The posterior arch (arcus posterior atlantis) features a posterior tubercle that functionally replaces the spinous process. On the upper surface of this arch, near the lateral masses, runs the groove for the vertebral artery (sulcus arteriae vertebralis). Occasionally, bone growth bridges this groove, converting it into a complete canal (canalis arteriae vertebralis).

The transverse processes of the atlas are direct extensions of the lateral masses and, like other cervical vertebrae, contain a transverse foramen for blood vessels.

Axis (C₂)

The second cervical vertebra is known as the axis (axis) or epistropheus (epistropheus). The primary anatomical landmark of this vertebra is the upward-projecting dens (dens axis).

The structure of the dens includes an apex (apex dentis) and two articular surfaces:

Otherwise, the axis resembles typical cervical elements. It features an arch enclosing the vertebral foramen (foramen vertebrale), as well as superior and inferior articular processes. Its spinous process is very massive, directed posteriorly, and bifid, serving as a landmark for identifying the bone's proper orientation. The transverse processes also contain foramina for vascular passage.

Vertebra Prominens (C₇)

The seventh cervical vertebra (C₇) terminates the cervical region and is named the vertebra prominens (vertebra prominens). It earned this name due to its long, massive, and non-bifid spinous process, which is easily palpated beneath the skin on the posterior aspect of the neck. This process serves as a convenient landmark for locating the junction between the cervical and thoracic regions of the vertebral column.

The shape of the body of the seventh vertebra closely resembles that of thoracic vertebrae. Another important distinction lies in the transverse foramina (foramina transversaria). In the vertebra prominens, these foramina are noticeably smaller than those of the vertebrae above. While the vertebral artery (a. vertebralis) and veins (vv. vertebrales) pass through the foramina from C₃ to C₆, only veins traverse the foramina of C₇.

Mnemonic

To remember atypical vertebrae: C₁ (Atlas) — a ring without a body; C₂ (Axis) — features a dens for rotation; C₇ (Vertebra Prominens) — has the longest non-bifid spinous process.

Frequently asked questions

Which ligaments participate in securing the dens of the axis within the median atlanto-axial joint?

The dens of the axis is secured within the median atlanto-axial joint by a ligamentous apparatus consisting of three structures:

  • Transverse ligament of the atlas (lig. transversum atlantis) — passes posterior to the dens, holding it in place against its posterior articular surface.
  • Alar ligaments (ligg. alaria) — thick internal check ligaments.
  • Apical ligament of the dens (lig. apicis dentis) — a thin vertical apical ligament.
What structures lie within the groove for the vertebral artery on the posterior arch of the atlas?

The atlanto-axial part of the vertebral artery lies within the groove on the posterior arch of the atlas.

  • Vertebral artery (arteria vertebralis) — courses through the groove of the same name (sulcus arteriae vertebralis), located on the upper surface of the posterior arch of the atlas near the lateral masses.

Sometimes this groove can transform into a closed foramen — the canal for the vertebral artery (canalis arteriae vertebralis).

The formation of which joints involves the uncinate processes of the cervical vertebral bodies?

The uncinate processes of the cervical vertebral bodies participate in the formation of uncovertebral joints.

  • Uncovertebral joints (joints of Luschka) — formed by the superior elevations on the lateral margins of the bodies of vertebrae C₃–C₇ (uncinate processes, or processus uncinatus), which articulate with the vertebra above.

These joints are present from C₂–C₃ to C₆–C₇. They facilitate flexion and extension, limit lateral movement, and protect against lateral and foraminal intervertebral disc herniations.

How can any cervical vertebra be distinguished from a thoracic or lumbar vertebra?

The primary distinguishing feature of all cervical vertebrae is the presence of a through transverse foramen (foramen transversarium) within the transverse process.

Why is the tubercle on the sixth cervical vertebra called the carotid tubercle?

The anterior tubercle of the sixth vertebra (C₆) is prominently developed and termed the carotid tubercle because the common carotid artery runs directly adjacent to it.

Does the vertebral artery pass through the seventh cervical vertebra?

No, only the vertebral veins pass through the small transverse foramina of the seventh cervical vertebra (C₇); the artery does not enter them.

What do the superior articular surfaces of the atlas articulate with?

The oval and deep superior articular surfaces of the first cervical vertebra form joints with the occipital condyles of the skull.

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