Cervical spinous process fracture

Background

• Isolated fracture of the spinous processes of the lower cervical or upper thoracic vertebrae
  • Caused by hyperflexion of neck → muscles pull on supraspinous ligament → avulsion fracture of spinous process
• Also known as "clay shoveler's" fracture
• A "stable" fracture
• C7 is most commonly affected

Clinical Features

• Pain in lower neck/upper back
• Tenderness over fracture site

Differential Diagnosis

Vertebral fractures and dislocations types

Vertebral anatomy.

Numbering order of vertebrae.

• Cervical fractures and dislocations
  • Atlanto-occipital dissociation
  • C1
    • Jefferson fracture
    • C1 isolated anterior arch fracture
    • C1 isolated posterior arch fracture
  • C2
    • Odontoid fracture
    • Hangman's fracture
  • C3-C7
    • Cervical burst fracture
    • Cervical spinous process fracture
    • Extension cervical teardrop fracture
    • Flexion cervical teardrop fracture
    • Anterior cervical wedge fracture
  • Cervical facet dislocation
  • Isolated transverse process fracture
• Thoracic and lumbar fractures and dislocations
  • Chance fracture
  • Thoracic burst fracture
  • Lumbar burst fracture
  • Isolated transverse process fracture
  • Thoracic and lumbar compression fractures

Evaluation

• Plain films or CT (preferred to eval for other injuries) of cervical/thoracic spine
• Neuro exam (fracture only rarely assoc w/neuro injury)

Management

• Prehospital Immobilization see NAEMSP National Guidelines for Spinal Immobilization
• Place in cervical collar - high rates of union with conservative management

Disposition

• Discharge

See Also

• Cervical spine injuries