Prevalence of Fusion Between Adjacent Cervical Spinous Processes in Adult Cadavers: A Cross-sectional Study

Introduction: Cervical spine surgery is associated with a considerable risk of performing procedures at the wrong level. Errors in accurately identifying the appropriate level for spinal interventions can result from various factors, including an inadequate understanding of anatomical variations, such as fusion of the Cervical Spinous Process (CPS), abnormalities at the craniocervical junction, cervical ribs, hemivertebrae, and blocked or fused vertebrae. Furthermore, patient-specific factors, including tumours, infections, previous cervical spine surgeries, obesity, and osteoporosis, significantly contribute to the incidence of surgeries performed at incorrect levels. Aim: To determine the prevalence of fusion between adjacent CPS. Materials and Methods: The present cross-sectional study examined the spinous processes of the cervical vertebrae in 30 formalin-preserved adult cadavers (15 males and 15 females), aged between 60 and 95 years, in Smt. BK Shah Medical College and Research Institute, Vadodara, Gujarat, India. Fusion between the CPS of adjacent vertebrae was recorded after the removal of soft-tissue from C1 to T1. Results: The present study found fusion between adjacent CPS in only 2 male (6.66%) cadavers. whereas none were observed in females.This fusion was exclusively observed between C2-C3 vertebrae The fused spinous processes demonstrated complete osseous continuity without visible fusion lines. Conclusion: CPS fusion is relatively uncommon in the adult Indian population; however, when it occurs, it is predominantly observed at the C2-C3 level in male cadavers. These findings provide a crucial reference for spinal surgeons to prevent surgical errors. Both preoperative and intraoperative imaging is essential for minimising surgical errors.