This usually refers to a fracture of the spinous process seen involving the lower cervical spine, usually C7. Initially described in workers who used to shovel clay and during the throwing phase, the clay may stick to the shovel jerking the trapezius or other muscles which are attached to the cervical spinous processes resulting in an avulsion fracture. This fracture may also occur with a whiplash injury or injuries that displace the arms upwards, neck hyperflexion, or a direct blow to the spinous process.
The fracture is stable. If the patient is neurologically intact, further imaging with flexion extension views or CT scans of the affected level to rule out other occult fractures that might have been missed on plain film radiography is recommended. A rigid collar may be used as needed for pain.
The radiographic features on the lateral view reveal avulsion type fracture involving the spinous process and on the AP view a ghost sign is seen referring to a double spinous process of C6 and C7 (Fig. 4.55) resulting from usually caudal displacement of the fractured spinous process [2, 5, 6].
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