• Journal of Korean Neurosurgical Society
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• v.52 no.6
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• pp.570-573
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• 2012

Avulsion of spinous process, also called Clay-shoveler's fracture, is most prevalent among those engaged in hard physical labor. To the best of the author's knowledge, only one case of multiple spinous process fractures of the upper thoracic spine in a novice golfer has been reported. A 45-year-old female presented with intractable posterior neck pain. The patient experienced a sharp, sudden pain on the neck while swinging a golf club, immediately after the club head struck the ground. Dynamic cervical radiographic findings were C6 and C7 spinous process fractures. Magnetic resonance imaging revealed C6 and C7 spinous process fractures without spinal cord pathology. The patient was treated with pain medications and cervical bracing. The patient's pain gradually improved. The injury mechanism was speculated to be similar to Clay-shoveler's fracture. Lower cervical spinous process fractures can be associated with a golf swing. If the patient complains of long lasting neck pain and has a history of golf activity, further study should be conducted to rule out lower cervical spinous fracture.

• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.2
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• pp.96-98
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• 2012

Fractures of isolated spinous processes of cervical and thoracic vertebrae are called as Clay shoveler's fracture. Such fractures related to sports activities are quite rare. In this report, a case of 27-year-old male with isolated spinous process fracture of C7 during golf swing is reported. The patient was prescribed on muscle relaxant and analgesic therapy. Cervical immobilization was maintained for four weeks with a cervical collar. The patient gradually recovered and was asymptomatic. He started playing golf twice a week after 5 months from the onset of pain.

• The Journal of Korean Physical Therapy
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• v.35 no.6
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• pp.163-166
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• 2023

A 30-year-old male novice golfer was diagnosed with a clay-shoveler's fracture. During golf practice, he experienced persistent posterior neck and upper back pain for a month. Cervical radiographs and computed tomography revealed a series of sequential spinous process fractures from C7 to T3. The patient was prescribed analgesic medication and fitted with a cervical brace alongside extracorporeal shockwave therapy (ESWT) directed explicitly toward the upper back region, subsequently leading to a notable reduction in pain. Therefore, ESWT could be considered an additional method for pain management in patients with clay-shoveler's fractures.

• Clinical Pain
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• v.19 no.2
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• pp.138-141
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• 2020

Clay-shoveler's fractures are rare stress-type avulsion fractures of the spinous processes especially in sports. There have been two case reports that discussed clay-shoveler's fractures in golf. A 36-year-old beginner golfer presented with a pain in the back after practicing golf swing. No fractures were detected using cervical radiography; however, computed tomography (CT) and magnetic resonance imaging (MRI) revealed T2~T3 spinous process fractures. The patient was treated conservatively and his pain subsided. The mechanism of injury is speculated to that of clay-shoveler's fractures. Therefore, if a golfer suffers persistent pain in the cervicothoracic region, clay-shoveler's fracture is one possibility to consider.

• Journal of Trauma and Injury
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• v.26 no.1
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• pp.30-33
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• 2013

A 55-year-old woman was seen in the emergency department with posterior neck pain and a headache after a traffic accident. Physical examination revealed tenderness on palpation over the posterior skull and a midline spinous process of the cervical spine without neurologic deficit. A plain radiograph of the cervical spine demonstrated the absence of the lateral portion of the posterior arch of the atlas and very lucent shadowing of the anterior midline of the atlas, suggesting a fracture of the anterior arch. On three-dimensional computed tomography (CT) of the cervical spine, anterior and posterior bony defects of the atlas were noted. Well-corticated defects were noted with sclerotic change and with no evidence of soft tissue swelling adjacent to the bony discontinuities, consistent with a congenital abnormality. With conservative therapy, the patient gradually showed a lessening of the midline tenderness. Careful investigation with radiography or CT is needed for these patients to avoid confusion with a fracture, because these patients seldom need surgical treatment.

• Journal of Korean Neurosurgical Society
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• v.64 no.4
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• pp.575-584
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• 2021

Objective : Cervical expansive laminoplasty is an effective surgical method to address multilevel cervical spinal stenosis. During surgery, the spinous processes of C2 and C7 are usually preserved to keep the insertion points of the cervical musculature and nuchal ligament intact. In this regard, dome-like laminectomy (undercutting of C7 lamina) instead of laminoplasty is performed on C7 in selected cases. However, resection of the lamina can weaken the C7 lamina, and stress fractures may occur, but this complication has not been characterized in the literature. The objective of the present study was to investigate the incidence and risk factors for C7 laminar fracture after C7 dome-like laminectomy and its impact on clinical and radiological outcomes. Methods : Patients who underwent cervical open-door laminoplasty combined with C7 dome-like laminectomy (n=123) were classified according to the presence of C7 laminar fracture. Clinical parameters (neck/arm pain score and neck disability index) and radiologic parameters (C2-7 angle, C2-7 sagittal vertical axis, and C7-T1 angle) were compared between the groups preoperatively and at postoperatively at 3, 6, 12, and 24 months. Risk factors for complications were evaluated, and a formula estimating C7 fracture risk was suggested. Results : C7 lamina fracture occurred in 32/123 (26%) patients and occurred at the bilateral isthmus in 29 patients and at the spinolaminar junction in three patients. All fractures appeared on X-ray within 3 months postoperatively, but patients did not present any neurological deterioration. The fracture spontaneously healed in 27/32 (84%) patients at 1 year and in 29/32 (91%) at 2 years. During follow-up, clinical outcomes were not significantly different between the groups. However, patients with C7 fractures showed a more lordotic C2-7 angle and kyphotic C7-T1 angle than patients without C7 fractures. C7 fracture was significantly associated with the extent of bone removal. By incorporating significant factors, the probability of C7 laminar fracture could be assessed with the formula 'Risk score = 1.08 × depth (%) + 1.03 × length (%, of the posterior height of C7 vertebral body)', and a cut-off value of 167.9% demonstrated a sensitivity of 90.3% and a specificity of 65.1% (area under the curve, 0.81). Conclusion : C7 laminar fracture can occur after C7 dome-like laminectomy when a substantial amount of lamina is resected. Although C7 fractures may not cause deleterious clinical outcomes, they can lead to an unharmonized cervical curvature. The chance of C7 fracture should be discussed in the shared decision-making process.

• Journal of Yeungnam Medical Science
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• v.10 no.1
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• pp.114-126
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• 1993

The fractures of the cervical spine are relatively uncommon, but they may cause serious neurologic deficits temporarily or permanently. So, it is very important to treat the patients early by way of exact evaluation for the sites and the mechanisms of the injuries. The authors reviewed retrospectively 188 cervical spinal fractures in 100 patients from Sep. 1984 to Aug. 1990. Commonly involved levels were $C_5$ and $C_6$ in lower cervical level and $C_2$ in upper cervical level and the sites in each spine were body, lamina and odontoid process. The hyperflexion injury was the most common type of the cervical spinal fractures occupying 53% of all cervical fractures and cause more multiple fractures(2.26 fractures/patient) than in hyperextension(1.68 fractures/patient). In hyperflexion injuries, body, transverse and spinous process were commonly involved but lamina fracture was relatively common in hyperextension injury. The dislocations associated with fractures were developed most commonly in hyperflexion injury and 70% of these were anterior dislocation and the most commonly involved levels were $C_{5-6}$ and $C_{6-7}$. In conclusion, hyperflexion injury needs more close examination for the entire spinal levels than injuries of other mechanisms because it results in more severe fractures with or without dislocation and relatively frequent multiple fractures in different levels.

• Journal of Veterinary Clinics
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• v.30 no.6
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• pp.499-502
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• 2013

An eight-year-old, castrated male, Poodle dog was presented with a bite wound in the neck region. Clinical examination revealed non-ambulatory signs of tetraparesis with deep pain, and upper motor neuron changes in all limbs. Fractures of the transverse process of C1 and the dorsal spinous process of C2 were observed on the radiographs and the computed tomography (CT). Conservative therapy was performed for 1 week. However the neurological problems were not alleviated until 7 days after injury. The owners agreed to perform surgical stabilization. The surgical stabilization was performed 7 days after presentation. Ventral stabilization was performed with screws, K-wires and bone cement. The dog stood up independently after 4 weeks and was able to walk 6 weeks postoperatively. In this report we suggest that using combined stabilization techniques are effective for this type of cervical fracture in which the dorsal and ventral structures of the vertebra are severely disrupted.

• Journal of Veterinary Clinics
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• v.26 no.5
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• pp.490-494
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• 2009

A 2-year-old Maltese and a 5-month-old Yorkshire terrier were presented with ataxia. Tetraparesis was observed in a 9-year -old Yorkshire terrier. The localizations of the lesions suggested brain or cervical spinal cord by the neurological examination, and the following images was achieved: radiography, axial images of computed tomography (CT), reconstruction image of CT such as multi-planar reformation(MPR) and 3-dimensional(3D) reconstruction and magnetic resonance imaging (MRI). On radiography, the misalignment between atlas (C1) and axis (C2), absent dens of axis, and increased space between the dorsal arch of C1 and spinous process of C2 were found. The discontinuation between dens and body of C2 was identified through axial CT images, and the fragmentation of dens separated from axis was observed through MPR and 3D image in all case. The hyperintense lesions and the spinal cord compression on T2-weighted MR images were represented in a dog with tetraparesis, the others represented only spinal cord compression. Three dogs were diagnosed as atlantoaxial instability (AAI) by dens fracture of C2. The dog with tetraparesis was euthanized due to guarded prognosis. The others were recovered completely. It is difficult to differentiate dens fracture of C2 from abnormal dens such as agenesis and hypoplasia. We thought that CT is very useful to evaluate the dens of C2 and differentiate the causes of AAI, and the reconstruction images of CT such as MPR and 3D make the translation of the fragmented dens or axis of AAI more precisely evaluate.