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Published on: November 8, 2024
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Traumatic isolated spinous process fractures.
Muhittin Emre Altunrende1, Elif Evrim Ekin2
1Department of Neurosurgery, Istinye University Faculty of Medicine, Istanbul-Türkiye.
Summary
Isolated spinous process fractures, often called Clay-Shoveler's fractures, can involve multiple vertebrae and indicate ligament damage. Further imaging is recommended to assess the full extent of injury and rule out complications.
Area of Science:
- Orthopedics
- Radiology
- Trauma Surgery
Background:
- Isolated traumatic spinous process fractures are uncommon spinal injuries.
- The cervical spine, particularly the cervicothoracic junction, is a frequent site for these fractures, often termed Clay-Shoveler's fractures.
- Understanding the causes, associated ligament injuries, and demographic factors is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the causes of traumatic spinous process fractures.
- To determine the incidence of associated spinal ligament injuries.
- To analyze the relationship between these fractures, age, and sex.
Main Methods:
- Retrospective review of spine Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans over five years.
- Exclusion of non-trauma cases, imaging artifacts, and prior spinal surgery.
- Classification of fracture etiology using International Classification of Diseases (ICD) codes and recording of demographic and injury data.
Main Results:
- 44 patients (36 male, 8 female, mean age 43.1 years) were included.
- Traffic accidents (25) and falls (18) were primary causes; fractures occurred in cervical (18), thoracic (17), and lumbar (3) regions.
- 15 patients had multiple fractures, 6 with cervicothoracic involvement (Clay-Shoveler's fracture). MRI revealed interspinous ligament damage in all cases examined, with no intracanal pathology.
Conclusions:
- Multiple spinous process fractures, especially at the cervicothoracic junction, can occur.
- While typically managed non-operatively, thorough evaluation of adjacent vertebrae is essential.
- Advanced imaging like MRI with Short-TI Inversion Recovery (STIR) sequences is vital for assessing ligamentous integrity and neural canal involvement.
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