Abstract:Clay-shoveler's fractures are isolated, avulsion-type spinous process fractures of the lower cervical and upper thoracic vertebrae. Multi-level fractures of the spinous processes are extremely rare. We report the case of a 60-year-old female patient with a six-level isolated spinous process fracture of the thoracic spine. Our case is the fourth reported case in literature, of an isolated spinous process fracture involving five or more levels in the thoracic vertebrae.
“…Isolated thoracic spinous process fractures in the setting of high-energy trauma are a rare occurrence. Involvement of five or more contiguous thoracic vertebral segments has been reported only three times previously in the literature [ 2 , 5 , 7 ]. In the acute setting, particularly following high-energy trauma, it is imperative to rule out other osseous and ligamentous damage to ensure spinal column stability before commencing with conservative treatment.…”
Section: Discussionmentioning
confidence: 99%
“…In the modern era, this fracture pattern has been observed in a variety of patients, including football players, power-lifters, golfers, and trauma patients [ 2 – 6 ]. There have been only three previous reports in the literature documenting isolated thoracic spinous process fractures involving five or more contiguous vertebrae [ 2 , 5 , 7 ]. Despite the paucity of published literature, this entity may be more common than previously believed.…”
Isolated thoracic spinous process fractures involving multiple adjacent vertebral segments are a rare occurrence in the setting of high-energy trauma. These findings should prompt further investigation to exclude other concomitant osseous or ligamentous injuries. Evaluation by computed tomography is often most useful to detect these fractures. Proper treatment of extensive multilevel injury is poorly defined in the literature. In our experience, conservative management consisting of initial bracing with graduated lifting restrictions has produced excellent functional results.
“…Isolated thoracic spinous process fractures in the setting of high-energy trauma are a rare occurrence. Involvement of five or more contiguous thoracic vertebral segments has been reported only three times previously in the literature [ 2 , 5 , 7 ]. In the acute setting, particularly following high-energy trauma, it is imperative to rule out other osseous and ligamentous damage to ensure spinal column stability before commencing with conservative treatment.…”
Section: Discussionmentioning
confidence: 99%
“…In the modern era, this fracture pattern has been observed in a variety of patients, including football players, power-lifters, golfers, and trauma patients [ 2 – 6 ]. There have been only three previous reports in the literature documenting isolated thoracic spinous process fractures involving five or more contiguous vertebrae [ 2 , 5 , 7 ]. Despite the paucity of published literature, this entity may be more common than previously believed.…”
Isolated thoracic spinous process fractures involving multiple adjacent vertebral segments are a rare occurrence in the setting of high-energy trauma. These findings should prompt further investigation to exclude other concomitant osseous or ligamentous injuries. Evaluation by computed tomography is often most useful to detect these fractures. Proper treatment of extensive multilevel injury is poorly defined in the literature. In our experience, conservative management consisting of initial bracing with graduated lifting restrictions has produced excellent functional results.
“…The clay was sticky and often glued to the shovel head creating an unexpected hyper-flexion and rotational force extending through the soft tissues of the labourer’s neck. 3 The energy, transmitted via the supra-spinous ligaments, caused avulsion fractures of the lower cervical spinous process (Figure 2). 3 Figure 1.Mr Reginald Dalton McKellar Hall (1897–1991) FRCS Author of ‘Reflections of an Orthopaedic Surgeon’.…”
Section: Originsmentioning
confidence: 99%
“…3 The energy, transmitted via the supra-spinous ligaments, caused avulsion fractures of the lower cervical spinous process (Figure 2). 3 Figure 1.Mr Reginald Dalton McKellar Hall (1897–1991) FRCS Author of ‘Reflections of an Orthopaedic Surgeon’. Photograph reproduced used with the permission of Mr Peter Bridges owner of hesperianpress.comFigure 2.Clay-shoveler’s fracture in C6.…”
The clay-shoveler's fracture is a stable oblique fracture through the spinous process of a lower cervical vertebra, classically C6 or C7. Diagnosed on plain radiograph, computed tomography and occasionally magnetic resonance imaging, the injury is most commonly seen in road traffic collisions in the modern-day. A stable injury, the clay-shoveler's fracture is managed non-operatively and requires symptomatic treatment only. This short article examines the history surrounding the injury and provides a comprehensive overview of the clay-shoveler's fracture for the non-spinal surgeon.
Typically, a clay shoveler’s fracture is a stress-type avulsion fracture involving the spinous processes of the lower cervical or upper thoracic vertebrae. Even though C7 and T1 are the most commonly involved spinal levels, these avulsion fractures can occur at any lower cervical or upper thoracic level, either as solitary or multiple fractures. This fracture used to be common in workers who shovel heavy loads of clay for long periods, hence its name. It does not cause any structural, functional, or neurological impairments and is therefore considered a stable fracture. Management is mostly conservative, involving rest, analgesics, and activity modification for a period of 4–6 weeks. Here, we present a 35-year-old male who sustained a motor vehicle accident. Except for midline tenderness in the back, there were no other positive findings. Plain radiographs showed a T11 vertebral compression fracture and absent or deviated spinous process shadows for most of the upper thoracic vertebrae. Computed tomography (CT) imaging clearly revealed multiple spinous process fractures extending from T2 to T8 levels. Considering the stability of these fractures, the patient was managed conservatively with rest, bracing, and analgesics. The recovery was quick, and he was back to his full functional status by six weeks.
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