During physical inspection of upper cervical spine alignment, what process is used to reliably identify the first vertebrae (Atlas or C1) of the spine at the base of the skull.

There is of course a line of bumps that are visible or that can be felt across the back of the neck. I am a little confused as to whether the highest one that can be identified in this way be the Atlas or the Axis; because I have seen some inconsistencies in the visual representations of the spine, specifically with the shape of the Atlas itself, and how far it protrudes in comparison to the Axis.

Is it normal for the Atlas to be felt, or only starting at the Axis?

  • I wonder if this is easier when observing changes after head rotation. From Wikipedia "The dens [atop the Axis] acts as a pivot that allows the atlas and attached head to rotate on the axis, side to side." Aug 31, 2016 at 15:22

1 Answer 1


The atlas can be felt. It's the first protuberance you feel at the top of the spine. The axis is the second one.


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