open access

Vol 82, No 3 (2023)
Original article
Submitted: 2022-06-10
Accepted: 2022-08-08
Published online: 2022-08-25
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Morphological analysis of C2–C7 spinous process bifurcation in Chinese population: a study using three-dimensional reconstruction of computed tomography

Z. Feng1, L. Liao1, H. Yang1, Y. Li1
·
Pubmed: 36165906
·
Folia Morphol 2023;82(3):596-602.
Affiliations
  1. School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China

open access

Vol 82, No 3 (2023)
ORIGINAL ARTICLES
Submitted: 2022-06-10
Accepted: 2022-08-08
Published online: 2022-08-25

Abstract

Background: This study aimed to investigate the anatomical morphology of the
C2 to C7 spinous process (SP) bifurcation (SPB) in the Chinese population and
reveal its potential clinical significance.
Materials and methods: Measurement parameters of the three-dimensional
(3D) reconstructions of neck computed tomography scans (n = 92 scans) were
retrospectively analysed. The 3D reconstruction and measurements were performed
using Mimics Research 19.0 and 3-Matic Research 11.0. Two independent
investigators reviewed all the data, including parameters such as the length and
angle of the SPB. The effects of age and sex were also analysed.
Results: We identified four morphological types of SPB: fully bifid (n = 252,
45.65%), partially bifid (n = 65, 11.78%), non-bifid (n = 226, 40.94%) and
unilateral branch (n = 9, 1.63%). The Kappa coefficients indicated good inter-observer
reproducibility (0.776), and the intraclass correlation coefficients (ICC)
values demonstrated excellent intra-rater reliability (ICC = 0.9, p < 0.0001) in
the classification and measurement of SPB parameters. The percentage of general
bifid SP was more than 70% in C2–5 and about 21% in C6, while all C7 SPs
presented non-bifid. Morphology was symmetrical in bifid and partially bifid SP,
while unilateral SP was not.
Conclusions: The classification system of SPB in this study proved consistent and
reliable, despite the subjective bias. Identifying the cervical level by C6 bifurcation
is unreliable, as nearly 80% of C6 SP is non-bifid. Our work provides an accurate
and effective anatomical reference for SPB studies in the Chinese population.

Abstract

Background: This study aimed to investigate the anatomical morphology of the
C2 to C7 spinous process (SP) bifurcation (SPB) in the Chinese population and
reveal its potential clinical significance.
Materials and methods: Measurement parameters of the three-dimensional
(3D) reconstructions of neck computed tomography scans (n = 92 scans) were
retrospectively analysed. The 3D reconstruction and measurements were performed
using Mimics Research 19.0 and 3-Matic Research 11.0. Two independent
investigators reviewed all the data, including parameters such as the length and
angle of the SPB. The effects of age and sex were also analysed.
Results: We identified four morphological types of SPB: fully bifid (n = 252,
45.65%), partially bifid (n = 65, 11.78%), non-bifid (n = 226, 40.94%) and
unilateral branch (n = 9, 1.63%). The Kappa coefficients indicated good inter-observer
reproducibility (0.776), and the intraclass correlation coefficients (ICC)
values demonstrated excellent intra-rater reliability (ICC = 0.9, p < 0.0001) in
the classification and measurement of SPB parameters. The percentage of general
bifid SP was more than 70% in C2–5 and about 21% in C6, while all C7 SPs
presented non-bifid. Morphology was symmetrical in bifid and partially bifid SP,
while unilateral SP was not.
Conclusions: The classification system of SPB in this study proved consistent and
reliable, despite the subjective bias. Identifying the cervical level by C6 bifurcation
is unreliable, as nearly 80% of C6 SP is non-bifid. Our work provides an accurate
and effective anatomical reference for SPB studies in the Chinese population.

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Keywords

cervical vertebra, spinous process, spinous process bifurcation, anatomy

About this article
Title

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

Journal

Folia Morphologica

Issue

Vol 82, No 3 (2023)

Article type

Original article

Pages

596-602

Published online

2022-08-25

Page views

919

Article views/downloads

639

DOI

10.5603/FM.a2022.0075

Pubmed

36165906

Bibliographic record

Folia Morphol 2023;82(3):596-602.

Keywords

cervical vertebra
spinous process
spinous process bifurcation
anatomy

Authors

Z. Feng
L. Liao
H. Yang
Y. Li

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