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# C7 vertebra

C7 is the lowest neck vertebra; its long spinous process is the bump felt at the base of the neck (vertebra prominens).

Official name: Vertebra prominens

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## What it is

The lowest neck vertebra, with a long spinous process you can feel at the base of the neck (the 'vertebra prominens').

## What it does

Stacks with the other neck vertebrae to hold up the head, protect the spinal cord and let the neck bend and turn.

## Key points

- Its long spine is the usual starting point for counting vertebrae from behind, but T1 is often just as prominent, so one-level counting errors are common
- A cervical rib from the C7 transverse process, or a fibrous band, can press on the lower trunk of the [brachial plexus](https://durgical.com/en/anatomy/roots-of-brachial-plexus/) and the subclavian artery: thoracic outlet syndrome
- C8 is the extra root: it leaves between C7 and T1, so from here down each root exits below the vertebra with the same number
- The cervicothoracic junction is the blind spot of lateral X-rays: injuries are missed unless C7–T1 is seen (swimmer's view or CT)

## Key facts

**Joints with**
C6 above (disc, facet and uncovertebral joints); T1 below ([C7–T1 disc](https://durgical.com/en/anatomy/c7-t1/) and facet joints)

**Landmarks**
Vertebra prominens: long non-bifid spinous process, easily felt; small transverse foramen, usually only vertebral veins pass; may carry a cervical rib

## Relations

**In front**
[Esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/) and [trachea](https://durgical.com/en/anatomy/trachea/); on the left the [thoracic duct](https://durgical.com/en/anatomy/thoracic-duct/) arches forward over the dome of the [pleura](https://durgical.com/en/anatomy/pleura/) at about this level to reach the junction of the internal jugular and subclavian veins

**Lateral**
Dome of the pleura and the [subclavian artery](https://durgical.com/en/anatomy/right-subclavian-artery/) below and in front; the cervicothoracic (stellate) ganglion of the [sympathetic trunk](https://durgical.com/en/anatomy/sympathetic-trunk/) lies in front of the transverse process; the [vertebral artery](https://durgical.com/en/anatomy/vertebral-artery/) usually passes in front of it to enter at C6

**Behind**
Long, non-bifid [spine](https://durgical.com/en/anatomy/region/spine/): attachment of the lower [nuchal ligament](https://durgical.com/en/anatomy/nuchal-ligament/), [trapezius](https://durgical.com/en/anatomy/trapezius-muscle/), [rhomboids](https://durgical.com/en/anatomy/rhomboid-major-muscle/) (minor) and [splenius](https://durgical.com/en/anatomy/splenius-capitis-muscle/)

**Contents**
[Spinal cord](https://durgical.com/en/anatomy/spinal-cord/) at about the C8 segment, the lowest part of the cervical enlargement (hand muscles)

## How to find it

A finger run down the back of the neck meets the first large spine that stays fixed when the head is tilted back: usually C7 (C6 slides forward and fades). To tell C7 from T1, the head is turned from side to side: C7 moves slightly under the finger, T1 stays still.

## Examination

- Elevated arm stress test (Roos): both arms held up with the elbows bent at shoulder height while the hands open and close for up to three minutes; early heaviness, numbness or inability to continue on one side supports thoracic outlet syndrome, though false positives are common
- Adson test: with the arm slightly extended, the head is turned toward that side and a deep breath held; loss of the radial pulse with symptoms points to compression of the subclavian artery, but the pulse also drops in many healthy people

## On imaging

A lateral cervical film must show the top of T1; the shoulders often hide it, so a swimmer's view (one arm raised) or CT is used. The AP view shows a cervical rib or a long C7 transverse process: C7 transverse processes point downwards, those of T1 upwards.

## Common problems

- Wear and bone spurs (cervical spondylosis), most often at [C5-C6](https://durgical.com/en/anatomy/c5-c6/) and [C6-C7](https://durgical.com/en/anatomy/c6-c7/).
- Spurs or a disc can narrow the canal (pressing the cord) or a side opening (pinching a nerve root).
- Fractures from falls, car accidents or diving.

## How it is diagnosed

X-rays show alignment and spurs. MRI shows discs, nerves and the spinal cord. CT shows bone detail.

## Treatment

- Most neck pain settles with time, activity changes, physical therapy and pain medicine.
- Surgery if a nerve or the cord is pressed and symptoms are severe or getting worse, for example ACDF.

## Clinical notes

- Clay-shoveler's fracture: avulsion of a lower cervical or upper thoracic spinous process, most often C7, from a sudden muscle pull; stable
- Thoracic outlet syndrome from a cervical rib is mostly neurogenic (ulnar-side hand numbness and wasting); the arterial form can cause a subclavian aneurysm and clots to the hand
- C8 radiculopathy (C7–T1 disc): weak finger flexors and small hand muscles and a numb little finger, to be told apart from [ulnar nerve](https://durgical.com/en/anatomy/ulnar-nerve/) entrapment

## Anatomical variants

- Cervical rib: commonly quoted in about 0.5–1% of people, often on both sides, mostly without symptoms
- A bifid spine is unusual at C7, unlike C2–C4
- In a minority the vertebral artery enters the transverse foramen of C7 (or a higher level) instead of C6

## Development

Every cervical transverse process includes a costal (rib) element, the anterior bar and tubercle; at C7 this element occasionally grows on its own into a cervical rib.

## Related conditions

- [Cervical Spondylosis](https://durgical.com/en/conditions/cervical-spondylosis/)
- [Cervical spine fracture](https://durgical.com/en/conditions/cervical-spine-fracture/)

## Test yourself

Think of the answer, then tap the question to see it.

## Why is the C7 vertebra called the vertebra prominens, and what is the pitfall when counting from it?

Its long, non-bifid spine is the usual starting point for counting, but T1 is often just as prominent, so one-level errors are common.

## By palpation, how is the spine of the C7 vertebra told apart from C6 and T1?

C6 slides forward and fades when the neck extends; when the head turns side to side, C7 moves slightly while T1 stays still.

## What can a cervical rib from the C7 vertebra compress?

The lower trunk of the brachial plexus and the subclavian artery: thoracic outlet syndrome, mostly neurogenic (ulnar-side hand numbness and wasting).

## What is a clay-shoveler's fracture, and which vertebra does it most often affect?

An avulsion of a spinous process from a sudden muscle pull, most often of the C7 vertebra; it is stable.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
vertebra prominens TA2 1057

**Official Spanish (DeCS)**
Vértebras cervicales DeCS D002574

**English (TA2)**
Vertebra prominens

**Also called**
vertebra C7 · os vertebrale prominens

## Related

- [C6–C7 disc](https://durgical.com/en/anatomy/c6-c7/)
- [C7–T1 disc](https://durgical.com/en/anatomy/c7-t1/)
- [Anterior longitudinal ligament](https://durgical.com/en/anatomy/anterior-longitudinal-ligament/)
- [Rib-to-spine ligaments](https://durgical.com/en/anatomy/radiate-ligament-of-head-of-rib/)
- [Endplates](https://durgical.com/en/anatomy/vertebral-endplates/)
- [Neck facet joints](https://durgical.com/en/anatomy/zygapophysial-joints/)
- [Interspinales](https://durgical.com/en/anatomy/interspinales-muscles/)
- [Interspinous ligaments](https://durgical.com/en/anatomy/interspinous-ligaments/)

Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=2614&filter=ths_termall&q=V%C3%A9rtebras%20Cervicales); [Anatomy, Head and Neck: Cervical Vertebrae](https://www.ncbi.nlm.nih.gov/books/NBK539734/); [Anatomy, Back, Cervical Vertebrae](https://www.ncbi.nlm.nih.gov/books/NBK459200/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/vertebra-prominens/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/vertebra-prominens/