Analysis of the uncinate processes of the cervical spine: an anatomical study

Laboratory investigation

R. Shane Tubbs M.S., P.A.-C., Ph.D.1, Olivia J. Rompala B.S.1, Ketan Verma B.S.1, Martin M. Mortazavi M.D.2, Brion Benninger M.D., M.Sc.3, Marios Loukas M.D., Ph.D.4, and M. Rene Chambers D.V.M., M.D.2
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  • 1 Section of Pediatric Neurosurgery, Children's Hospital, Birmingham;
  • | 2 Division of Neurosurgery, University of Alabama at Birmingham, Alabama;
  • | 3 Departments of Clinical Anatomy, Samaritan Orthopaedic & Surgery Residency Programs Faculty and Family Practice, COMP-Northwest, Western University of Health Sciences, Lebanon; Departments of Orthopaedics, Surgery, Oral Maxillofacial Surgery, and Integrative Biosciences, Oregon Health & Science University, Portland, Oregon; and
  • | 4 Department of Anatomical Sciences, St. George's University, Grenada
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Although the uncovertebral region is neurosurgically relevant, relatively little is reported in the literature, specifically the neurosurgical literature, regarding its anatomy. Therefore, the present study aimed at further elucidation of this region's morphological features.


Morphometry was performed on the uncinate processes of 40 adult human skeletons. Additionally, range of motion testing was performed, with special attention given to the uncinate processes. Finally, these excrescences were classified based on their encroachment on the adjacent intervertebral foramen.


The height of these processes was on average 4.8 mm, and there was an inverse relationship between height of the uncinate process and the size of the intervertebral foramen. Degeneration of the vertebral body (VB) did not correlate with whether the uncinate process effaced the intervertebral foramen. The taller uncinate processes tended to be located below C-3 vertebral levels, and their average anteroposterior length was 8 mm. The average thickness was found to be 4.9 mm for the base and 1.8 mm for the apex. There were no significant differences found between vertebral level and thickness of the uncinate process. Arthritic changes of the cervical VBs did not necessarily deform the uncinate processes. With axial rotation, the intervertebral discs were noted to be driven into the ipsilateral uncinate process. With lateral flexion, the ipsilateral uncinate processes aided the ipsilateral facet joints in maintaining the integrity of the ipsilateral intervertebral foramen.


A good appreciation for the anatomy of the uncinate processes is important to the neurosurgeon who operates on the spine. It is hoped that the data presented herein will decrease complications during surgical approaches to the cervical spine.

Abbreviations used in this paper:

AP = anteroposterior; VB = vertebral body.

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  • 1

    Braakman R, & Penning L: Injuries of the Cervical Spine Amsterdam, Excerpta Medica, 1971

  • 2

    Clausen JD, , Goel VK, , Traynelis VC, & Scifert J: Uncinate processes and Luschka joints influence the biomechanics of the cervical spine: quantification using a finite element model of the C5–C6 segment. J Orthop Res 15:342347, 1997

    • Search Google Scholar
    • Export Citation
  • 3

    Fielding JW, & Stillwell WT: Anterior cervical approach to the upper thoracic spine. Spine 1:158161, 1976

  • 4

    Gieger M, , Roth PA, & Wu JK: The anterior cervical approach to the cervicothoracic junction. Neurosurgery 37:704710, 1995

  • 5

    Hacker RJ, & Miller CG: Failed anterior cervical foraminotomy. J Neurosurg 98:2 Suppl 126130, 2003

  • 6

    Hadley LA: The covertebral articulations and cervical foramen encroachment. J Bone Joint Surg Am 39-A:910920, 1957

  • 7

    Hall MC: Luschka's Joint Springfield, IL, Charles C Thomas, 1965

  • 8

    Hayashi K, & Yabuki T: Origin of the uncus and of Luschka's joint in the cervical spine. J Bone Joint Surg Am 67:788791, 1985

  • 9

    Kotani Y, , McNulty PS, , Abumi K, , Cunningham BW, , Kaneda K, & McAfee PC: The role of anteromedial foraminotomy and the uncovertebral joints in the stability of the cervical spine. A biomechanical study. Spine (Phila Pa 1976) 23:15591565, 1998

    • Search Google Scholar
    • Export Citation
  • 10

    Lang J: Skeletal system of the cervical spine. Clinical Anatomy of the Cervical Spine Thieme, New York, 5354, 1993

  • 11

    Lu J, , Ebraheim NA, , Yang H, , Skie M, & Yeasting RA: Cervical uncinate process: an anatomic study for anterior decompression of the cervical spine. Surg Radiol Anat 20:249252, 1998

    • Search Google Scholar
    • Export Citation
  • 12

    Luschka H: Die Anatomie des Menschen in Rücksicht auf das Bedürfnis der praktischen Heilkunde Tübingen, H. Laupp, 18621869, (3 volumes)

    • Search Google Scholar
    • Export Citation
  • 13

    Mummaneni PV, , Robinson JC, & Haid RW Jr: Cervical arthroplasty with the PRESTIGE LP cervical disc. Neurosurgery 60:4 Suppl 2 310315, 2007

    • Search Google Scholar
    • Export Citation
  • 14

    Orofino C, , Sherman MS, & Schechter D: Luschka's joint—a degenerative phenomenon. J Bone Joint Surg Am 42-A:853858, 1960

  • 15

    Panjabi MM: The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord 5:390397, 1992

  • 16

    Penning L, & Wilmink JT: Rotation of the cervical spine. A CT study in normal subjects. Spine (Phila Pa 1976) 12:732738, 1987

  • 17

    Schmieder K, , Kettner A, , Brenke C, , Harders A, , Pechlivanis I, & Wilke HJ: In vitro flexibility of the cervical spine after ventral uncoforaminotomy. Laboratory investigation. J Neurosurg Spine 7:537541, 2007

    • Search Google Scholar
    • Export Citation
  • 18

    Toendury G: [The cervical spine, its development and changes during life.]. Acta Orthop Belg 25:602626, 1959. (Fr)

  • 19

    Tubbs RS, , Vahedi P, , Loukas M, , Shoja MM, & Cohen-Gadol AA: Hubert von Luschka (1820–1875): his life, discoveries, and contributions to our understanding of the nervous system. Historical vignette. J Neurosurg 114:268272, 2011

    • Search Google Scholar
    • Export Citation
  • 20

    Willis TA: Luschka's joints. Clin Orthop Relat Res 46:121125, 1966

  • 21

    Yilmazlar S, , Kocaeli H, , Uz A, & Tekdemir I: Clinical importance of ligamentous and osseous structures in the cervical uncovertebral foraminal region. Clin Anat 16:404410, 2003

    • Search Google Scholar
    • Export Citation
  • 22

    Yonenobu K, , Okada K, , Fuji T, , Fujiwara K, , Yamashita K, & Ono K: Causes of neurologic deterioration following surgical treatment of cervical myelopathy. Spine (Phila Pa 1976) 11:818823, 1986

    • Search Google Scholar
    • Export Citation


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