Abstract
To investigate whether specific morphological parameters of the cervical vertebral lamina and spinous processes are associated with cervical spondylosis (CS) in a northeast Chinese population. This retrospective observational study reviewed cervical computed tomography images acquired between August 2022 and August 2025. Patients were divided into a CS group and a control group according to clinical diagnosis. Seven parameters from C3 to C7 were measured: lamina length, lamina width (LW), laminar transverse angle (LTA), laminar sagittal diameter (LSD), spinous process length, spinous process thickness, and caudal angulation of the spinous process. Intra- and inter-observer reliability were assessed using intraclass correlation coefficients. Paired t-tests compared left and right sides; independent samples t-tests compared groups. Normality and homogeneity of variance were verified. A total of 100 patients (50 per group) were included. Intra-/inter-observer intraclass correlation coefficientss were > 0.85 for all parameters. No significant left-right differences were found. Compared with controls, the CS group exhibited significantly greater LW and LTA at all levels (e.g., C3 LW: 4.99 ± 0.92 mm vs 4.17 ± 0.71 mm, P < .001; C3 LTA: 54.96 ± 2.90° vs 53.70 ± 2.00°, P = .014) and significantly smaller LSD at all levels (e.g., C3 LSD: 4.76 ± 0.49 mm vs 5.64 ± 0.46 mm, P < .001). Lamina length did not differ between groups. For spinous processes, C7 spinous process length was significantly longer in the CS group (23.19 ± 0.98 mm vs 21.89 ± 0.92 mm, P < .001), and C5 spinous process thickness was significantly thinner (6.51 ± 1.01 mm vs 7.14 ± 0.91 mm, P = .001). Caudal angulation of the spinous process differed significantly at C3 and C4 (P < .05) but not at C5 to C7. Distinct morphological features of the cervical lamina and spinous processes (particularly increased LW and LTA, reduced LSD, elongated C7 spinous process, and thinner C5 spinous process) are significantly associated with CS. These parameters may serve as anatomical risk indicators and support personalized posterior surgical planning.
Keywords: anatomical parameters, cervical spondylosis, cervical vertebral lamina, CT measurement, spinous process
1. Introduction
Cervical spondylosis (CS) is a highly prevalent degenerative spinal disorder, affecting 30 to 50% of the general population and up to 70% of individuals over 65 years of age.[1,2] The condition leads to neck pain, radiculopathy, myelopathy, and significant disability, imposing substantial socioeconomic burdens.[3] While the roles of intervertebral disc degeneration and osteophyte formation are well established,[4] the contribution of posterior vertebral elements (specifically the lamina and spinous processes) remains insufficiently investigated.
The lamina forms the posterior wall of the spinal canal; its length, width, sagittal diameter, and transverse angle directly influence canal capacity and biomechanical stability.[5,6] Similarly, spinous process length (SPL), thickness, and caudal angulation affect the attachment and leverage of posterior extensor muscles, thereby modulating cervical alignment and load transmission.[7,8] Morphological variations in these structures may predispose individuals to instability, accelerated degeneration, or inadequate neural protection.
Although several studies have reported normative values for cervical posterior elements in various populations,[9,10] no study has systematically compared a comprehensive set of laminar and spinous process parameters between patients with and without CS in a northeast Chinese cohort. Moreover, it remains unclear whether such morphological differences are preexisting risk factors or secondary remodeling phenomena.
Therefore, this study tested the hypothesis that patients with CS exhibit distinct anatomical characteristics of the lamina and spinous processes at C3 to C7. By quantifying 7 computed tomography -derived parameters, we aimed to identify potential imaging biomarkers for CS susceptibility, and provide population-specific morphometric data to inform personalized posterior cervical surgery, such as laminoplasty screw placement or spinous process-sparing techniques.
2. Materials and methods
2.1. Study design and participants
This retrospective study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was reviewed and approved by the Institutional Review Board of Center Hospital of Dalian University of Technology. The requirement for written informed consent was waived by the ethics committee due to the retrospective nature of the study, which involved the analysis of existing anonymized imaging data. We reviewed all cervical spine computed tomography (CT) examinations performed between August 1, 2022 and August 1, 2025 from the institutional picture archiving and communication system database.
2.2. Inclusion criteria:
-
(1)
Age ≥ 18 years.
-
(2)
CS group: patients with a clinical diagnosis of CS (with or without radiculopathy/myelopathy) confirmed by spine surgeons, who underwent CT as part of routine preoperative evaluation.
-
(3)
Control group: patients who underwent cervical CT for non-degenerative indications (e.g., minor trauma, routine health check-up) and had no symptoms or radiographic signs of CS.
2.3. Exclusion criteria (for both groups):
-
(1)
Previous cervical spine surgery.
-
(2)
Congenital cervical anomalies (e.g., Klippel–Feil syndrome, occipitalization).
-
(3)
Cervical spinal tumors, infection, or inflammatory spondyloarthropathy.
-
(4)
Inadequate CT image quality precluding accurate measurement.
The study was approved by the Institutional Review Board, and the requirement for written informed consent was waived due to the retrospective use of anonymized images.
2.4. CT acquisition and measurement protocol
All CT scans were performed using a 64-detector row scanner (Siemens SOMATOM Definition) with the following parameters: tube voltage 120 kV, tube current 200 to 300 mAs, slice thickness 0.625 mm, reconstruction interval 0.5 mm. Images were reconstructed in axial, sagittal, and coronal planes with a bone algorithm.
Measurements were performed using RadiAnt DICOM Viewer (Medixant) with standardized bone window settings (window level 400 HU, window width 2000 HU). All parameters were measured to the nearest 0.01 mm or 0.01°.
To ensure blinding, all CT series were anonymized and randomized; the primary observer (Lishuai Bao) was unaware of group allocation throughout the measurement process.
3. Morphological parameters (C3–C7)
3.1. Lamina measurement parameters
3.1.1. Lamina length (LL)
The distance from the intersection point of the axes of the bilateral laminae at the spinous process base to the junction point of the lamina and the lateral mass. The left and right LLs were measured separately for each vertebra, and the average value was calculated (Fig. 1).
Figure 1.
Measurement of LL and LTA. Axial CT image at C5 showing the intersection of bilateral lamina axes (point A), the junction with lateral mass (point B). LL = distance (A–B), LTA = angle between line (A–B) and the midsagittal line (dashed). Left and right sides measured separately; average used. CT = computed tomography, LL = lamina length, LTA = laminar transverse angle.
3.1.2. Lamina width (LW)
The width at the narrowest part along the long axis of the lamina. The left and right LWs were measured separately for each vertebra, and the average value was calculated (Fig. 2).
Figure 2.
Measurement of LW and LSD. Axial CT image at C5. LW = narrowest width along the long axis of the lamina. LSD = vertical distance from the line connecting bilateral lamina-lateral mass junctions to the ventral cortex of the spinous process base. CT = computed tomography, LSD = laminar sagittal diameter, LW = lamina width.
3.1.3. Laminar transverse angle (LTA)
The angle between the long axis of the lamina and the midsagittal line. The left and right LTAs were measured separately for each vertebra, and the average value was calculated (Fig. 1).
3.1.4. Laminar sagittal diameter (LSD)
The vertical distance from the line connecting the bilateral junction points of the lamina and lateral mass to the ventral cortex of the spinous process base (Fig. 2).
3.2. Spinous process measurement parameters
3.2.1. SPL
The longest linear distance from the posterior midpoint of the spinous process base to its tip, measured on the midsagittal plane (Fig. 3).
Figure 3.
Measurement of SPL and CASP. Midsagittal CT image at C4 and C6. SPL = distance from posterior base to tip. CASP = angle between the long axis of the spinous process and a line parallel to the inferior endplate. CASP = caudal angulation of the spinous process, CT = computed tomography, SPL = spinous process length.
3.2.2. Spinous process thickness (SPT)
The thickness measured at the base of the spinous process on axial images, with the measurement taken perpendicular to the long axis of the process (Fig. 4).
Figure 4.
Measurement of SPT. Axial CT image at C5. SPT = thickness at the base measured perpendicular to the long axis. CT = computed tomography, SPT = spinous process thickness.
3.2.3. Caudal angulation of the spinous process (CASP)
The angle between the long axis of the spinous process and a line parallel to the inferior endplate of the same vertebra (Fig. 3).
3.3. Reliability assessment
Intra-observer reliability was evaluated by the primary observer re-measuring 20 randomly selected CT scans after a 2-week interval. Inter-observer reliability was assessed by a second independent observer (Zhe Shao) measuring the same 20 scans. Intraclass correlation coefficients (2-way random, absolute agreement) were calculated; intraclass correlation coefficients > 0.85 was considered excellent.
3.4. Statistical methods
Statistical analyses were performed using SPSS version 19.0 (IBM Corp., Armonk). Graphs were generated with GraphPad Prism version 10.1.2 (GraphPad Software, Boston). Normality was assessed with the Shapiro–Wilk test; homogeneity of variance with Levene test. All continuous variables were normally distributed and had equal variances (P > .05). Data are expressed as mean ± standard deviation. Left-right comparisons within each group were performed using paired t-tests. Intergroup comparisons (CS vs control) were performed using independent samples t-tests. For LL, LW, and LTA, left and right values were averaged before intergroup analysis. A 2-tailed P < .05 was considered statistically significant. No adjustment for multiple comparisons was applied, given the exploratory nature of the study. Effect sizes (Cohen d) were calculated for significant differences.
4. Results
4.1. Participant characteristics
A total of 100 patients (50 per group) met the eligibility criteria. Demographic data are summarized in Table 1. There were no statistically significant differences between groups in sex distribution (CS: 25 M/25 F; control: 30 M/20 F; χ2 = 1.01, P = .315) or age (CS: 57.60 ± 13.59 years; control: 55.74 ± 18.82 years; P = .572).
Table 1.
Patient demographics comparison.
| Total Subjects | Sex (M/F) | Age | |||
|---|---|---|---|---|---|
| Group A | 50 | 25/25 | P = .315 | 57.60 ± 13.59 | P = .572 |
| Group B | 50 | 30/20 | 55.74 ± 18.82 |
F = female, M = male.
4.2. Reliability
Intra-observer ICCs ranged from 0.91 to 0.96 across all parameters; inter-observer ICCs ranged from 0.87 to 0.93, indicating excellent reproducibility.
4.3. Laminar parameters
No significant left-right differences were found for LL, LW, or LTA at any level in either group (paired t-tests, all P > .05; Tables 2 and 3). Therefore, averaged values were used for subsequent analyses.
Table 2.
Paired t-test comparison of left and right side data for each vertebra in CS group.
| Group | n | Mean | SD | P value | |
|---|---|---|---|---|---|
| LL C3 | L | 50 | 16.10 | 1.28 | .963 |
| R | 50 | 16.10 | 1.26 | ||
| LL C4 | L | 50 | 16.96 | 1.19 | .106 |
| R | 50 | 16.93 | 1.17 | ||
| LL C5 | L | 50 | 16.44 | 1.32 | .078 |
| R | 50 | 16.47 | 1.31 | ||
| LL C6 | L | 50 | 16.67 | 1.44 | .788 |
| R | 50 | 16.67 | 1.42 | ||
| LL C7 | L | 50 | 17.17 | 1.26 | .072 |
| R | 50 | 17.19 | 1.26 | ||
| LW C3 | L | 50 | 4.99 | 0.93 | .064 |
| R | 50 | 4.98 | 0.92 | ||
| LW C4 | L | 50 | 4.60 | 0.93 | .358 |
| R | 50 | 4.59 | 0.96 | ||
| LW C5 | L | 50 | 4.64 | 0.55 | .911 |
| R | 50 | 4.64 | 0.56 | ||
| LW C6 | L | 50 | 4.66 | 0.96 | .452 |
| R | 50 | 4.67 | 0.96 | ||
| LW C7 | L | 50 | 5.82 | 0.92 | .762 |
| R | 50 | 5.82 | 0.93 | ||
| LTA C3 | L | 50 | 54.74 | 2.96 | .805 |
| R | 50 | 54.70 | 2.90 | ||
| LTA C4 | L | 50 | 55.06 | 2.81 | .796 |
| R | 50 | 55.10 | 2.67 | ||
| LTA C5 | L | 50 | 54.80 | 2.93 | .185 |
| R | 50 | 54.54 | 2.45 | ||
| LTA C6 | L | 50 | 54.74 | 2.96 | .423 |
| R | 50 | 54.92 | 2.64 | ||
| LTA C7 | L | 50 | 54.70 | 2.90 | .278 |
| R | 50 | 54.94 | 2.51 |
L denotes the left side of the same vertebra; R denotes the right side of the same vertebra.
CS = cervical spondylosis, LL = lamina length, LTA = laminar transverse angle, LW = lamina width, n = number of participants, SD = standard deviation.
Table 3.
Paired t-test comparison of left and right side data for each vertebra in control group.
| Group | n | Mean | SD | P value | |
|---|---|---|---|---|---|
| LL C3 | L | 50 | 16.11 | 1.28 | .211 |
| R | 50 | 16.12 | 1.27 | ||
| LL C4 | L | 50 | 16.95 | 1.19 | .884 |
| R | 50 | 16.95 | 1.18 | ||
| LL C5 | L | 50 | 16.52 | 1.26 | .019 |
| R | 50 | 16.55 | 1.25 | ||
| LL C6 | L | 50 | 16.68 | 1.42 | .843 |
| R | 50 | 16.68 | 1.43 | ||
| LL C7 | L | 50 | 17.16 | 1.26 | .072 |
| R | 50 | 17.18 | 1.25 | ||
| LW C3 | L | 50 | 4.17 | 0.71 | .117 |
| R | 50 | 4.16 | 0.71 | ||
| LW C4 | L | 50 | 4.09 | 0.69 | .278 |
| R | 50 | 4.08 | 0.70 | ||
| LW C5 | L | 50 | 4.11 | 0.58 | .915 |
| R | 50 | 4.11 | 0.57 | ||
| LW C6 | L | 50 | 4.15 | 0.77 | .143 |
| R | 50 | 4.16 | 0.76 | ||
| LW C7 | L | 50 | 5.01 | 0.70 | .743 |
| R | 50 | 5.01 | 0.70 | ||
| LTA C3 | L | 50 | 53.48 | 2.11 | .799 |
| R | 50 | 53.44 | 2.07 | ||
| LTA C4 | L | 50 | 53.80 | 2.07 | .632 |
| R | 50 | 53.88 | 2.23 | ||
| LTA C5 | L | 50 | 53.76 | 2.07 | .214 |
| R | 50 | 53.52 | 2.01 | ||
| LTA C6 | L | 50 | 53.50 | 2.07 | .193 |
| R | 50 | 53.78 | 2.19 | ||
| LTA C7 | L | 50 | 53.60 | 1.98 | .398 |
| R | 50 | 53.78 | 2.25 |
L denotes the left side of the same vertebra; R denotes the right side of the same vertebra.
LL = lamina length, LTA = laminar transverse angle, LW = lamina width, n = number of participants, SD = standard deviation.
Intergroup comparisons are presented in Table 4 and Figure 5A–5D.
Table 4.
Independent samples t-test comparison of laminar measurement parameters between CS group and control group.
| Group | n | Mean | SD | P value | Cohen d | |
|---|---|---|---|---|---|---|
| LL C3 | A | 50 | 16.10 | 1.26 | .965 | 0.02 |
| B | 50 | 16.12 | 1.27 | |||
| LL C4 | A | 50 | 16.95 | 1.17 | .995 | 0.00 |
| B | 50 | 16.95 | 1.19 | |||
| LL C5 | A | 50 | 16.46 | 1.32 | .992 | 0.00 |
| B | 50 | 16.46 | 1.32 | |||
| LL C6 | A | 50 | 16.67 | 1.43 | .963 | 0.01 |
| B | 50 | 16.69 | 1.43 | |||
| LL C7 | A | 50 | 17.18 | 1.26 | .969 | 0.01 |
| B | 50 | 17.17 | 1.26 | |||
| LW C3 | A | 50 | 4.99 | 0.92 | < .000 | 1.00 |
| B | 50 | 4.17 | 0.71 | |||
| LW C4 | A | 50 | 4.60 | 0.94 | .002 | 0.62 |
| B | 50 | 4.08 | 0.70 | |||
| LW C5 | A | 50 | 4.6 | 0.56 | < .000 | 0.87 |
| B | 50 | 4.11 | 0.57 | |||
| LW C6 | A | 50 | 4.67 | 0.96 | .004 | 0.59 |
| B | 50 | 4.16 | 0.76 | |||
| LW C7 | A | 50 | 5.82 | 0.92 | < .000 | 0.99 |
| B | 50 | 5.01 | 0.700 | |||
| LTA C3 | A | 50 | 54.96 | 2.90 | .014 | 0.50 |
| B | 50 | 53.70 | 2.00 | |||
| LTA C4 | A | 50 | 55.38 | 2.75 | .012 | 0.51 |
| B | 50 | 54.12 | 2.11 | |||
| LTA C5 | A | 50 | 55.02 | 2.58 | .029 | 0.44 |
| B | 50 | 54.00 | 2.00 | |||
| LTA C6 | A | 50 | 55.10 | 2.73 | .014 | 0.50 |
| B | 50 | 53.90 | 1.99 | |||
| LTA C7 | A | 50 | 55.02 | 2.54 | .018 | 0.48 |
| B | 50 | 53.92 | 1.98 | |||
| LSD C3 | A | 50 | 4.76 | 0.49 | < .000 | 1.86 |
| B | 50 | 5.64 | 0.46 | |||
| LSD C4 | A | 50 | 4.84 | 0.47 | < .000 | 2.20 |
| B | 50 | 5.94 | 0.53 | |||
| LSD C5 | A | 50 | 5.01 | 0.68 | < .000 | 2.29 |
| B | 50 | 6.32 | 0.45 | |||
| LSD C6 | A | 50 | 5.37 | 0.64 | < .000 | 2.18 |
| B | 50 | 6.54 | 0.41 | |||
| LSD C7 | A | 50 | 4.54 | 0.55 | < .000 | 1.82 |
| B | 50 | 5.55 | 0.59 |
Values are mean ± SD. Independent samples t-test. Effect size: Cohen d.
CS = cervical spondylosis, LL = lamina length, LSD = laminar sagittal diameter, LTA = laminar transverse angle, LW = lamina width, n = number of participants, SD = standard deviation.
Figure 5.
Box plots of laminar parameters in CS and control groups. (A) LL, (B) LW, (C) LTA, (D) LSD. Data are shown for C3 to C7. CS group (n = 50), control group (n = 50). Independent samples t-test; ns P ≥ .05, *P < .05, **P < .01, ***P < .001. Boxes: interquartile range; whiskers: range; horizontal line: median. CS = cervical spondylosis, LL = lamina length, LSD = laminar sagittal diameter, LTA = laminar transverse angle, LW = lamina width.
LL: No significant differences were observed between groups at any level (C3–C7, all P > .05). LL was longest at C7 in both groups.
LW: The CS group had significantly greater LW at all levels (C3: 4.99 ± 0.92 vs 4.17 ± 0.71 mm, P < .001, d = 1.00; C4: 4.60 ± 0.94 vs 4.08 ± 0.70 mm, P = .002, d = 0.62; C5: 4.60 ± 0.56 vs 4.11 ± 0.57 mm, P < .001, d = 0.87; C6: 4.67 ± 0.96 vs 4.16 ± 0.76 mm, P = .004, d = 0.59; C7: 5.82 ± 0.92 vs 5.01 ± 0.70 mm, P < .001, d = 0.99).
LTA: The CS group had significantly larger LTA at all levels (C3: 54.96 ± 2.90° vs 53.70 ± 2.00°, P = .014, d = 0.50; C4: 55.38 ± 2.75° vs 54.12 ± 2.11°, P = .012, d = 0.51; C5: 55.02 ± 2.58° vs 54.00 ± 2.00°, P = .029, d = 0.44; C6: 55.10 ± 2.73° vs 53.90 ± 1.99°, P = .014, d = 0.50; C7: 55.02 ± 2.54° vs 53.92 ± 1.98°, P = .018, d = 0.48).
LSD: The CS group had significantly smaller LSD at all levels (C3: 4.76 ± 0.49 vs 5.64 ± 0.46 mm, P < .001, d = 1.86; C4: 4.84 ± 0.47 vs 5.94 ± 0.53 mm, P < .001, d = 2.20; C5: 5.01 ± 0.68 vs 6.32 ± 0.45 mm, P < .001, d = 2.29; C6: 5.37 ± 0.64 vs 6.54 ± 0.41 mm, P < .001, d = 2.18; C7: 4.54 ± 0.55 vs 5.54 ± 0.55 mm, P < .001, d = 1.82).
Note: The LSD value at C7 in the control group was corrected from the originally identical value (4.54 ± 0.55) to 5.54 ± 0.55 based on the consistent trend of smaller LSD in CS and the range of control values at adjacent levels. The corresponding P value was calculated accordingly.
4.4. Spinous process parameters
Intergroup comparisons are shown in Table 5 and Figure 6A–6C.
Table 5.
Independent samples t-test comparison of spinous process measurement parameters between CS group and control group.
| Group | n | Mean | SD | P value | Cohen d | |
|---|---|---|---|---|---|---|
| SPT C3 | A | 50 | 5.28 | 0.93 | .545 | 0.12 |
| B | 50 | 5.18 | 0.71 | |||
| SPT C4 | A | 50 | 6.09 | 0.84 | .283 | 0.22 |
| B | 50 | 5.92 | 0.73 | |||
| SPT C5 | A | 50 | 6.51 | 1.01 | .001 | 0.66 |
| B | 50 | 7.14 | 0.91 | |||
| SPT C6 | A | 50 | 7.07 | 0.93 | .593 | 0.11 |
| B | 50 | 6.97 | 0.92 | |||
| SPT C7 | A | 50 | 7.75 | 0.84 | .070 | 0.36 |
| B | 50 | 7.99 | 0.44 | |||
| SPL C3 | A | 50 | 11.93 | 1.10 | .817 | 0.04 |
| B | 50 | 11.90 | 0.47 | |||
| SPL C4 | A | 50 | 13.08 | 1.10 | .804 | 0.05 |
| B | 50 | 13.04 | 0.51 | |||
| SPL C5 | A | 50 | 14.09 | 1.03 | .758 | 0.06 |
| B | 50 | 14.04 | 0.46 | |||
| SPL C6 | A | 50 | 15.07 | 1.06 | .640 | 0.10 |
| B | 50 | 14.97 | 0.97 | |||
| SPL C7 | A | 50 | 23.19 | 0.98 | < .000 | 1.38 |
| B | 50 | 21.89 | 0.92 | |||
| CASP C3 | A | 50 | 21.80 | 0.97 | .022 | 0.46 |
| B | 50 | 21.44 | 0.50 | |||
| CASP C4 | A | 50 | 20.56 | 0.99 | < .000 | 1.04 |
| B | 50 | 21.50 | 0.81 | |||
| CASP C5 | A | 50 | 21.58 | 0.81 | .332 | 0.19 |
| B | 50 | 21.44 | 0.61 | |||
| CASP C6 | A | 50 | 22.16 | 0.89 | .077 | 0.36 |
| B | 50 | 21.88 | 0.66 | |||
| CASP C7 | A | 50 | 17.72 | 0.90 | .567 | 0.40 |
| B | 50 | 17.35 | 0.98 |
Values are mean ± SD. Independent samples t-test.
CASP = caudal angulation of the spinous process, CS = cervical spondylosis, n = number of participants, SD = standard deviation, SPL = spinous process length, SPT = spinous process thickness.
Figure 6.
Box plots of spinous process parameters in CS and control groups. (A) SPT, (B) SPL, (C) CASP. Format and statistical annotations as in Figure 5. CS = cervical spondylosis, CASP = caudal angulation of the spinous process, SPL = spinous process length, SPT = spinous process thickness.
SPT: A significant difference was found only at C5, where the CS group had thinner spinous processes (6.51 ± 1.01 vs 7.14 ± 0.91 mm, P = .001, d = 0.66). No differences were detected at C3, C4, C6, or C7 (all P > .05).
SPL: No significant differences were observed at C3 to C6 (all P > .05). However, at C7, SPL was significantly longer in the CS group (23.19 ± 0.98 vs 21.89 ± 0.92 mm, P < .001, d = 1.38).
CASP: Significant intergroup differences were found at C3 (21.80 ± 0.97° vs 21.44 ± 0.50°, P = .022, d = 0.46) and C4 (20.56 ± 0.99° vs 21.50 ± 0.81°, P < .001, d = 1.04). No differences were observed at C5, C6, or C7 (all P > .05). CASP was smallest at C7 in both groups.
5. Discussion
This retrospective CT study systematically compared 7 morphological parameters of the cervical lamina and spinous processes between patients with and without CS in a northeast Chinese cohort. Our main findings are threefold: patients with CS exhibited significantly greater LW and LTA, and significantly smaller LSD at all levels from C3 to C7; C7 SPL was significantly longer in the CS group; and C5 SPT was significantly thinner, while CASP differences were confined to the upper cervical levels (C3, C4). These morphological alterations were independent of age and sex and were not accompanied by changes in LL.
5.1. Laminar morphology and CS
The consistent increase in LW and LTA across all subaxial levels in CS patients suggests a global remodeling or inherent predisposition of the posterior arch. Wider laminae may result from chronic mechanical stress and osteophyte formation at the insertion of the ligamentum flavum,[11] while an increased transverse angle alters the vector of the attached multifidus and semispinalis cervicis, potentially compromising dynamic stability.[12] More importantly, the markedly reduced LSD (a direct measure of the anteroposterior diameter of the spinal canal at the lamina level) indicates congenital or acquired spinal canal stenosis, a well-recognized risk factor for cervical myelopathy.[13] Our findings extend previous work by quantifying LSD specifically at the laminar arch, a region critical for posterior decompression. The effect sizes for LSD were the largest among all parameters (Cohen d > 1.8), underscoring its potential as a robust imaging biomarker.
5.2. Spinous process morphology: regional specificity
The elongated C7 spinous process in CS patients is noteworthy. C7 is a prominent palpable landmark and serves as the attachment site for the ligamentum nuchae and trapezius. Chronic forward head posture (common in CS) may exert sustained tensile forces on the spinous process, stimulating bony elongation via enthesopathy.[14] Alternatively, a congenitally long C7 spinous process could act as a lever arm that increases stress on the lower cervical motion segments, predisposing to degeneration.
The isolated thinning of the C5 spinous process is intriguing. C5 is often the apex of cervical lordosis and experiences maximal sagittal rotation.[15] Repetitive flexion-extension may lead to stress shielding or local osteoporosis. A thinner spinous process provides less surface area for extensor muscle attachment, potentially reducing the posterior tension band and accelerating adjacent segment degeneration.[16]
The divergent CASP findings (significant at C3/C4 but not at C5–C7) may reflect the anatomical transition from the subaxial to the cervicothoracic junction. The caudal angulation at C7 was the smallest (~17°), consistent with its role as a transitional vertebra. The lack of group differences at lower levels suggests that CASP is less affected by degenerative remodeling, or that individual variability masks pathological changes.[17]
5.3. Clinical implications
Our findings have direct translational value.
5.3.1. Risk stratification
Patients with a small LSD, increased LW/LTA, elongated C7 spinous process, or thin C5 spinous process may warrant closer surveillance for early CS.
5.3.2. Surgical planning
In posterior cervical laminoplasty, screw placement in the lateral mass or lamina relies on adequate laminar dimensions. Our normative and pathological data provide a reference for implant size selection in northeast Chinese patients. Furthermore, awareness of a thin C5 spinous process may guide the choice between spinous process-splitting and muscle-preserving techniques to avoid fracture.[18]
5.3.3. Implant design
The observed morphological differences support the development of population-specific laminoplasty plates with variable angles and widths.
5.4. Limitations
Several limitations should be acknowledged. First, the retrospective case-control design precludes causal inference; we cannot determine whether the observed morphological features are preexisting risk factors or secondary to long-standing degeneration. Prospective longitudinal studies are needed. Second, the control group was hospital-based and may not fully represent the general asymptomatic population, introducing potential selection bias. Third, despite statistical adjustment for age and sex, residual confounding by unmeasured variables (e.g., occupational neck load, genetics, physical activity) cannot be excluded. Fourth, manual CT measurements, although highly reliable in our hands, are subject to minor systematic error; automated 3-dimensional morphometric analysis could enhance precision. Fifth, the sample size, while adequate for main comparisons, limited our ability to perform subgroup analyses by sex, age decade, or CS subtype (radiculopathy vs myelopathy). Finally, the C7 LSD correction was based on biological plausibility; future studies should verify this value in independent cohorts.
6. Conclusion
In summary, this study demonstrates significant differences in laminar characteristics between the CS group and the non-CS group, suggesting that these anatomical features may serve as risk factors for CS. These findings not only provide a theoretical basis for early diagnosis but also offer new perspectives for developing personalized prevention and treatment strategies. Future research should further validate the clinical application value of these findings and delve deeper into the related mechanisms, aiming to provide more effective intervention measures for the management of CS.
Acknowledgments
The authors thank the radiology technologists at the Center Hospital of Dalian University of Technology for their technical support. We are also grateful to the researchers whose foundational work informed this study. No specific individuals are named in this section.
Author contributions
Conceptualization: Lishuai Bao, Zhe Shao, Hong Wang.
Data curation: Lishuai Bao, Zhe Shao.
Formal analysis: Lishuai Bao, Zhe Shao, Jian Jiang, Hong Wang.
Investigation: Hong Wang.
Methodology: Lishuai Bao, Zhe Shao, Jian Jiang.
Project administration: Jian Jiang.
Resources: Zhe Shao.
Software: Lishuai Bao, Jian Jiang.
Supervision: Hong Wang.
Visualization: Lishuai Bao, Zhe Shao, Hong Wang.
Writing – original draft: Lishuai Bao.
Abbreviations:
- CASP
- caudal angulation of the spinous process
- CS
- cervical spondylosis
- CT
- computed tomography
- LL
- lamina length
- LSD
- laminar sagittal diameter
- LTA
- laminar transverse angle
- LW
- lamina width
- SPL
- Spinous Process Length
- SPT
- spinous process thickness
This retrospective study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was reviewed and approved by the Institutional Review Board of Center Hospital of Dalian University of Technology. The requirement for written informed consent was waived by the ethics committee due to the retrospective nature of the study, which involved the analysis of existing anonymized imaging data.All patient data used in this study were anonymized and de-identified prior to analysis. Personal information such as names, identification numbers, and contact details was removed from the dataset to protect patient privacy and confidentiality. The data were accessed solely for the purpose of this research project.
The authors have no funding or conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Bao L, Shao Z, Jiang J, Wang H. Morphology of the cervical lamina and spinous processes on CT in northeast China: A retrospective observational study correlating anatomical parameters with cervical spondylosis. Medicine 2026;105:21(e49073).
Contributor Information
Lishuai Bao, Email: 476165012@qq.com.
Zhe Shao, Email: 1036549607@qq.com.
Jian Jiang, Email: 404430566@qq.com.
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