{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:14:38Z","timestamp":1787318078084,"version":"build-2736575974"},"reference-count":60,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T00:00:00Z","timestamp":1618790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Anatomy"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Cervical spinal injury and neck pain are common disorders with wide physical implications. Neck pain and disability are reported to occur in females more often than in males, and chronic or persistent neck pain after whiplash is twice as common in females. Female athletes also sustain a higher percentage of concussions compared to male athletes. Still, while sexual differences in clinical presentation and outcome are well\u2010established, the underlying etiology for the disparity remains less clear. It is well\u2010established that the origin and insertion landmarks of posterior neck muscles are highly variable, but we do not know if these interindividual differences are associated with sex. Expanding our knowledge on sexual dimorphism in the anatomy of the cervical muscles is essential to our understanding of the possible biomechanical differences between the sexes and hence improves our understanding as to why females suffer from cervical pain more than males. It is also of paramount importance for accurate planning of posterior cervical spine surgery, which cuts through the posterior cervical musculature. Therefore, our main objective is to characterize the anatomy of posterior neck musculature and to explore possible sexual differences in the location of their attachment points. Meticulous posterior neck dissection was performed on 35 cadavers, 19 females, and 16 males. In each specimen, 8 muscle groups were examined bilaterally at 45 osseous anatomical landmarks. Muscles and their attachment sites were evaluated manually then photographed and recorded using Microscribe Digitizer technology built into 3D models. A comparison of attachment landmarks between males and females for each muscle was conducted. Out of the eight muscles that were measured, only two muscles demonstrated significant sex\u2010related anatomical differences\u2014Spinotranversales (splenius capitis and cervicis) and Multifidus. Male Spinotransversales muscle has more attachment points than female. It showed more cranial insertion points in the upper cervical attachments (superior nuchal line, C\n                    <jats:sub>1<\/jats:sub>\n                    posterior tubercle, and mastoid process) and more caudal insertion points in the spinous processes and transverse processes of the lower cervical and upper thoracic vertebrae. Thus, the male subjects in this study exhibited a greater coverage of the posterior neck both cranially and caudally. Female Multifidus has more attachment points on the spinous processes and articular processes at middle and lower cervical vertebrae and at the transverse processes of the upper thoracic vertebrae. All remaining muscles exhibited no sexual differences. Our findings highlight, for the first time, a sexual dimorphism in attachment points of posterior cervical musculature. It reinforces the notion that the female neck is not a scaled version of the male neck. These differences in muscle attachment could partially explain differences in muscle torque production and range of motion and thus biomechanical differences in cervical spine stabilization between sexes. It sheds a much\u2010needed light on the reason for higher whiplash rates, concussion, and chronic cervical pain among females. Surgeons should take these sexual morphological differences into consideration when deliberating the best surgical approach for posterior cervical surgery.\n                  <\/jats:p>","DOI":"10.1111\/joa.13448","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T02:12:23Z","timestamp":1618884743000},"page":"589-601","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Sexual dimorphism of the posterior cervical spine muscle attachments"],"prefix":"10.1111","volume":"239","author":[{"given":"Lee","family":"Keidan","sequence":"first","affiliation":[{"name":"Department of Anatomy and Anthropology Sackler Faculty of Medicine Tel\u2010Aviv University Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alon","family":"Barash","sequence":"additional","affiliation":[{"name":"Azrieli Faculty of Medicine Bar Ilan University Safed Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziv","family":"Lenzner","sequence":"additional","affiliation":[{"name":"Screen Based Art Department Bezalel Academy of Arts and Design Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaim G.","family":"Pick","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Anthropology Sackler Faculty of Medicine Tel\u2010Aviv University Tel\u2010Aviv Israel"},{"name":"Sagol School of Neuroscience Tel Aviv University Tel Aviv Israel"},{"name":"The Dr. Miriam and Sheldon G. Adelson Chair and Center for the Biology of Addictive Diseases Tel\u2010Aviv University Tel\u2010Aviv Israel"},{"name":"Sylvan Adams Sports Institute Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6279-6935","authenticated-orcid":false,"given":"Ella","family":"Been","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Anthropology Sackler Faculty of Medicine Tel\u2010Aviv University Tel\u2010Aviv Israel"},{"name":"Department of Sports Therapy Faculty of Health Professions Ono Academic College Kiryat Ono 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