Presentation
Presentation 50 years-old male with neck pain after shovelling snow. Patient Data Age: 55 Gender: Male Lateral x-ray shows spinous process fractures from C3 to C5. Bilateral fracture of C6 laminae. The patient is wearing a cervical collar. [radiopaedia.org]
He presented to a direct-access physical therapy clinic. [ncbi.nlm.nih.gov]
Common sports-related problems faced by primary care practitioners are thoroughly and concisely presented in the famous fast-access 5-Minute Consult format. [books.google.com]
Such fractures are rarely observed in present times with the advent of industrialization and reduced weight-bearing activities. [jmedicalcasereports.biomedcentral.com]
Entire Body System
- Falling
Causes Spinous process fractures are caused by severe trauma to the back such as: Falls Car, motorcycle, or pedestrian accidents Severe and sudden twisting or bending Severe blows to the back and spine Violence, such as a gunshot Risk Factors Spinous [winchesterhospital.org]
There are no treatments for SCA3, but technical aids can help prevent falls and certain medications can help with certain symptoms such as spasticity. [lacaf.org]
Our case may have occurred by direct trauma after a 7-m fall. On literature, cases of over 5-level spinous process fractures were extremely rare; and all were treated conservatively [1,2,3,4,5,6]. [ncbi.nlm.nih.gov]
- Weakness
When to seek medical advice Call your healthcare provider right away if any of the following occur: Increasing back or abdominal pain Weakness, dizziness or fainting Blood in your urine (pink, red or brownish color) Weakness or numbness in one or both [fairview.org]
Is my back weak? Weak back and especially core and abdomen muscles will be unable to support the back sufficiently leading to pain and tiredness. [sportsinjuryclinic.net]
If the fracture compresses the spinal cord or spinal nerve roots there can be pain, numbness, reflex changes, and weakness in the distribution of skin and muscle supplied by that nerve. [neurosurgery.ufl.edu]
They may cause: Severe pain that may be worse when moving, coughing, or breathing Swelling and bruising Numbness, tingling, or weak muscles Problems moving the injured part of the spine Loss of bladder or bowel control Unstable fractures may cause damage [winchesterhospital.org]
The most common cause of weakening is osteoporosis, a condition that causes weak and brittle bones. Osteoporosis is most common in elderly women, and it is for this reason that elderly women are the group most affected by compression fracture. [columbiaspine.org]
- Ecchymosis
[…] injuries in which there is distraction of the posterior elements and impaction of the anterior components of the spine o Compression component from hyperflexion is usually minor compared to distraction component o Back pain is the most common symptom o Ecchymosis [learningradiology.com]
He had neither ecchymosis nor swelling of the back, and was without neurological deficits. There were no significant fractures on simple lateral thoracic and lumbar X-ray (Fig. 1). [ncbi.nlm.nih.gov]
- Asymptomatic
The patient was completely asymptomatic with well-maintained spinal alignment 10 weeks after his injury (Figure 2). At that point, he was allowed to return to full activities without any restriction. (a) (b) (a) (b) 2.2. [hindawi.com]
Patient was asymptomatic 3 months after treatment and the serum biochemistry was normal (Serum Calcium 2.54 mmol/l and serum ALP 285 IU/l) Insufficiency fractures are most often seen in elderly females who have postmenopausal osteoporosis [1],[3]. [ijoonline.com]
Genetic studies are now available to patients and asymptomatic carriers. [elsevier.es]
The effect of an analgesic mobilization technique when applied at symptomatic or asymptomatic levels of the cervical spine in subjects with neck pain: A randomized controlled trial. J Man Manip Ther 2009;17:101-8. [jkspm.org]
VCFs can also be caused by substantial trauma (e.g. automobile accident, gunshot wound or sports injury) and can be asymptomatic or entail minor symptoms. [ana-neurosurgery.com]
- Fatigue
The second may be regarded as a stress-related, fatigue-type fracture. [synapse.koreamed.org]
Von Zumbusch psoriasis can cause fever, chills, weight loss and fatigue. Palmoplantar pustulosis This causes pustules to appear on the palms of your hands and the soles of your feet. [www2.hse.ie]
Fatigue, insufficiency and pathologic fractures. J Am Med Assoc 1964;187:1001-1004. 5. Hirsh LF, Duarte LE, Wolfson EH, Gerhard W. Isolated symptomatic cervical spinous process fracture requiring surgery: Case report. [ijoonline.com]
Metallic artifacts obscure the contact surface between the device and bone, but usually a thin fatigue cortical erosion can be suspected. [ajnr.org]
[…] as: Reduced mobility 7, loss of balance 6, and increased risk of falls 8-10 Reduced ability to take care of yourself 11 Reduced days of activity 5,6 and more days in bed 2 Decreased appetite 5,6 and sleep disorders 12,14 Chronic back pain 13,14 and fatigue [back.com]
Respiratoric
- Cough
They may cause: Severe pain that may be worse when moving, coughing, or breathing Swelling and bruising Numbness, tingling, or weak muscles Problems moving the injured part of the spine Loss of bladder or bowel control Unstable fractures may cause damage [winchesterhospital.org]
Or, spinal fractures may be caused by simple movements like coughing or sneezing if your vertebrae have become weak and brittle from osteoporosis or cancer. [back.com]
It is often triggered by a minor movement, such as bending over to pick something up and often made worse by sitting, coughing or sneezing. A slipped disc (prolapsed disc) is a common cause of sciatic pain, but there are a number of others. [sportsinjuryclinic.net]
Eyes
- Foreign Body Sensation
Headache, pulling sensation with eye movement and foreign body sensation in the eye are the most common complaints. These symptoms typically last only several days. [aapos.org]
Musculoskeletal
- Fracture
Eleven spinous process fractures were identified by CT in 11 patients (22.0% of levels). No fractures were apparent on plain radiographs. [ncbi.nlm.nih.gov]
In golf, the mechanism of the cervical injury is similar to that of occupational Clay-shoveler's fracture. Clay-shoveler's fracture represents an avulsion type of fracture of the spinous process in the lower cervical or upper thoracic spine. [synapse.koreamed.org]
The identification of the fracture on the preliminary anteroposterior film can serve as a guide and warning that other components of the cervical or thoracic vertebrae may be fractured. [pubs.rsna.org]
- Back Pain
Recommended Articles: When Back Pain Is a Spine Compression Fracture Managing and Preventing Spine Fractures Multiple Compression Fractures In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues [spine-health.com]
Significant leg pain that came on after experiencing severe back pain. Referred pain into the legs and/or feet following a back injury, especially if the symptoms do not decrease within 24 hours. [sportsinjuryclinic.net]
Low-back pain in athletes. J Bone Joint Surg Am. 2004; 86:382–396. Hosalker H, Dormans J. Back pain in children requires extensive workup. Biomechanics. 2003; 10:51–58. Sassmannshausen G, Smith BG. Back pain in the young athlete. [healio.com]
Case Report A 47-year-old man was admitted to our emergency department with back pains, after a 7 m-fall injury. He complained of severe back pains of visual analog scale (VAS) score 8, and had no past medical history. [ncbi.nlm.nih.gov]
- Osteoporosis
They may be difficult to detect, especially in the presence of osteoporosis [7]. [ijoonline.com]
[…] by bone fragility even without a definite diagnosis of osteoporosis. [ajnr.org]
A clay-shoveler's fracture with renal transplantation and osteoporosis: a case report. [jmedicalcasereports.biomedcentral.com]
Or, spinal fractures may be caused by simple movements like coughing or sneezing if your vertebrae have become weak and brittle from osteoporosis or cancer. [back.com]
If the fracture is caused by osteoporosis, treatment of the osteoporosis can help prevent additional fractures. Treatment may include calcium and vitamin D supplements, bisphosphonates, and weight bearing exercises. [columbiaspine.org]
- Neck Pain
pain that radiated bilaterally into the shoulder area. [insights.ovid.com]
A 21-year-old male military academy cadet developed acute posterior neck pain after performing multiple sets of overhead shoulder presses and resting the bar on his lower neck and shoulders. He presented to a direct-access physical therapy clinic. [ncbi.nlm.nih.gov]
Neck pain in the general population. Spine (Phila Pa 1976) 1994;19:1307-9. Cote P, Cassidy JD, and Carroll LJ et al. The annual incidence and course of neck pain in the general population: A population-based cohort study. Pain 2004;112:267-73. [jkspm.org]
Presentation 50 years-old male with neck pain after shovelling snow. Patient Data Age: 55 Gender: Male Lateral x-ray shows spinous process fractures from C3 to C5. Bilateral fracture of C6 laminae. The patient is wearing a cervical collar. [radiopaedia.org]
Case Report A 37-year-old man had a sudden lower posterior neck pain. [synapse.koreamed.org]
- Contusion
Case Images Diagnosis Spinous Process Avulsion Fracture Clinical Notes Clinical and radiographic injuries include: seatbelt pattern contusion, right clavicle fracture, left pneumothorax and pulmonary contusions, and splenic laceration. [advancedradteaching.com]
Magnetic resonance imaging (MRI) scan showed the same contiguous fractures without any cord contusions [Figure 2]. The patient was given muscle relaxant and analgesic therapy. [neurologyindia.com]
Anterior view of multiple spinal cord contusions caused by burst compression fractures of the middle and lower thoracic spine. [emedicine.medscape.com]
Bone marrow edema in several vertebral bodies, either due to contusion or fracture. Interspinous edema and disruption of the ligamenta flava C7-Th1 and supraspinous ligament Th1-Th2. [radiologyassistant.nl]
Psychiatrical
- Withdrawn
During injection, the needle was progressively withdrawn to fill the dorsal components of the spinous process. [ajnr.org]
Neurologic
- Tingling
Spinous process fractures can produce an array of symptoms, including: Back pain Decreased ability to turn or bend their back A 'crunch' sound when moving, bending or twisting their back Numbness or tingling radiating from where the fracture occurred [study.com]
While surgery may not reverse spinal cord damage, it can also be necessary to prevent further problems such as pain or deformity, or to halt the progression of neurological problems such as weakness, tingling, or bowel/bladder problems. [ana-neurosurgery.com]
They may cause: Severe pain that may be worse when moving, coughing, or breathing Swelling and bruising Numbness, tingling, or weak muscles Problems moving the injured part of the spine Loss of bladder or bowel control Unstable fractures may cause damage [winchesterhospital.org]
A more severe form of a compression fracture is a burst fracture, and these can require surgery if the fracture is pushing on nerves and causing numbness, tingling, or weakness in the legs or arms due to the fracture. [texasspinecare.com]
- Irritability
Psoriasis in between the thighs may also be more easily irritated from rubbing when you walk, run or move. Wearing spandex shorts beneath clothes or using baby powder can help to decrease the friction and reduce irritation. [psoriasis.org]
Chronic pain or long-term irritation to the area could be associated with the muscle and tendon junctions that insert on the original spinous process or avulsion segment. [chiropractor-sioux-city.com]
Wear cotton next to your skin – cotton is much less likely to irritate your skin compared with other fabrics, such as wool. If your skin is irritated, you’re more likely to scratch. [irishskin.ie]
- Paresthesia
There was also a history of night pains at the cervicodorsal site and pain and paresthesia of the upper extremity and chest. Neurological examination was normal. [jmedicalcasereports.biomedcentral.com]
“Pins and needles” (paresthesia) feeling or “loss if feeling” (anaesthesia) in the legs or feet. [sportsinjuryclinic.net]
- Quadriplegia
[…] process) (closed) 805.8 with hematomyelia - see Fracture, vertebra, by site, with spinal cord injury injury to paralysis - see Fracture, vertebra, by site, with spinal cord injury paraplegia - see Fracture, vertebra, by site, with spinal cord injury quadriplegia [icd9data.com]
- Excitement
Leszek Kolakowski: Jester at the Court of Marxism The name of Leszek Kolakowski is famous outside the borders of his native Poland and far beyond the circle of professional philosophers, not because his doctrines are exciting like Sartre’s or his discoveries [dissentmagazine.org]
Workup
As part of the initial workup, plain radiographs and magnetic resonance images (MRI) were obtained. [healio.com]
X-Ray
- Cervical Spine X-Ray
Initial cervical spine X-rays showed an isolated spinous process fracture C-7 vertebra (Figure 1). In the lateral dynamic flexion-extention views, the bone fragments and vertebral body were not mobile and stable. [synapse.koreamed.org]
Figure 1: (a) X-ray cervical spine (lateral view) showing shoulder shadow obscuring fracture vertebrae; (b) computed tomography (CT) cervical spine showing contiguous fracture of the spinous process of C-6 to D-4 vertebae; (c) axial section of CT cervical [neurologyindia.com]
Treatment
The case of a patient with a persistently symptomatic C-2 spinous process fracture that required surgical treatment for pain relief is reported. [ncbi.nlm.nih.gov]
Nonoperative NSAIDS, rest, immobilization in hard collar for comfort indications most common treatment for pain control modalities short term treatment with hard collar outcomes usually high union rates and excellent clincal outcomes Operative surgical [orthobullets.com]
Surgical excision of the spinous process fragment is the treatment of choice in these symptomatic patients who are refractory to nonoperative management. [hindawi.com]
Topical treatments Topical treatments are usually the first treatments used for mild to moderate psoriasis. These are creams and ointments you apply to affected areas. [www2.hse.ie]
Prognosis
[…] usually occurs midway between the spinous tip and lamina risk factors labourers racket or contact sports motor vehicle accidents Associated conditions usually occurs in isolation other orthopaedic injuries to consider lamina fracture facet dislocations Prognosis [orthobullets.com]
[…] intestinal and urinary bladder injuries o Since the spinal cord ends at T12-L1, injuries to cord are infrequent but the spinal nerves may be injured resulting in bowel and bladder signs § Those with a kyphosis of less than 15° have a better neurologic prognosis [learningradiology.com]
The prognosis for SCA6 and SCA11 is less severe with a very slow worsening of symptoms, and persons with SCA8 and SCA11 have a normal lifespan. [secure.ssa.gov]
Here, we'll report the case of a sports-related cervical spinous process fracture with a discussion on the causative mechanism, treatment and prognosis. Case Report A 37-year-old man had a sudden lower posterior neck pain. [synapse.koreamed.org]
Disease progression and severity often depend on the type of SCA.[1] Most available information on the prognosis of SCA is based on the four most common types: SCA1, SCA2, SCA3 and SCA6. [rarediseases.info.nih.gov]
Etiology
[…] and multiple body system manifestations due to the underlying etiology. [icd10data.com]
[…] encounter for closed fracture See all Unspecified fracture of unspecified vertebra ICD-10 Coding Spinous Process Fracture ICD-9 805 Fracture of vertbral column without spinal cord injury; neural arch, spine, spinous process Spinous Process Fracture Etiology [eorif.com]
Etiology: In general, compared with adults, pediatric patients have greater ligamentous flexibility and elasticity, shallower and more horizontal facets, and relative paraspinal muscle immaturity. [posna.org]
For instance, serum protein electrophoresis and urine protein electrophoresis tests are ordered to evaluate for multiple myeloma, the most common form of bone cancer in elderly patients and frequent etiology of pathologic compression fractures. [uscspine.com]
Epidemiology
Epidemiology of Vertebral Fractures. J Clin Densitom. Jan-Mar 2016;19(1):8-22. Kevin Phan, Prashanth J Rao, Ralph J Mobbs. [danielebarnabei.it]
[…] for closed fracture See all Unspecified fracture of unspecified vertebra ICD-10 Coding Spinous Process Fracture ICD-9 805 Fracture of vertbral column without spinal cord injury; neural arch, spine, spinous process Spinous Process Fracture Etiology / Epidemiology [eorif.com]
Introduction Avulsion-type spinous process fracture in the lower cervical or upper thoracic spine Epidemiology incidence rare demographics direct trauma to posterior spinous process indirect trauma sudden muscular/ligamentous pull in flexion or extension [orthobullets.com]
Epidemiology and outcomes of osteoporotic fractures. Lancet 2002 ;359:1761-1767. Based on company data/sales estimates. [back.com]
Pathophysiology
The understanding of pathophysiology and molecular mechanisms of SCAs requires multidisciplinary approaches ranging from molecular, cellular biology, proteomic and transcriptomic analysis, cerebellar physiology, medicinal chemistry, transgenic model animal [frontiersin.org]
Clinical, genetic, molecular, and pathophysiological insights into spinocerebellar ataxia type 1. Cerebellum. 2008;7(2):106-14. doi: 10.1007/s12311-008-0009-0. Review. Zoghbi HY, Orr HT. [ghr.nlm.nih.gov]
The anatomy and pathophysiology of neck pain. Phyl MedRehabilClin N Am 2011;22:367-82. Bovim G, Schrader H, and Sand T. Neck pain in the general population. Spine (Phila Pa 1976) 1994;19:1307-9. Cote P, Cassidy JD, and Carroll LJ et al. [jkspm.org]
According to the authors, the differences in sensitivity were significant for both comparisons. [8] Pathophysiology Compression fractures of the thoracic spine occur when a vertical force with or without a flexion or rotational sheer force exceeds the [emedicine.medscape.com]
Prevention
Treatments There are no treatments for SCA2, but technical aids can help prevent falls. Occupational therapy, physiotherapy, and speech therapy can be done in order to limit functional losses and to prevent certain complications. [lacaf.org]
Prevention Most fractures happen due to accidents. Healthy bones and muscles may help prevent injury. This may be done through diet and exercise. [winchesterhospital.org]
Moreover, the thick and avascular cortex of the lamina is supposed to prevent intravascular migration of the cement. [ajnr.org]
Vertebroplasty subgroup in group II did not show benefit even in preventing such kyphotic alignment change, whereas instrumentation subgroup in group II showed lordotic alignment restoration despite more severe kyphotic alignment at the time of injury [ncbi.nlm.nih.gov]
During these surgical procedures, the surgeon injects a cement mixture into the fractured bone to stabilize the fracture, treat pain, and prevent a spinal deformity from progressing. [columbiaspine.org]