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Mohamed Boucetta - One of the best experts on this subject based on the ideXlab platform.
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multiple isolated thoracic Spinous Process fractures clay shoveler s fracture
The Spine Journal, 2011Co-Authors: Ali Akhaddar, Abad Elasri, Mohamed BoucettaAbstract:Clay-Shoveler’s fracture is an isolated Spinous Process fracture typically observed in the lower cervical or upper thoracic spine [1]. Multiple involvements are rare [1–4]. A 40-year-old car driver was involved in a road traffic accident with the seat belt buckled up. Clinical examination revealed an extensive tenderness on the skin over the posterior thoracic spine without neurological deficits. Computed tomography scanning of the cervicothoracic spine showed multiple thoracic Spinous Process fractures
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Multiple isolated thoracic Spinous Process fractures (Clay-Shoveler’s fracture)
The Spine Journal, 2011Co-Authors: Ali Akhaddar, Abad Elasri, Mohamed BoucettaAbstract:Clay-Shoveler’s fracture is an isolated Spinous Process fracture typically observed in the lower cervical or upper thoracic spine [1]. Multiple involvements are rare [1–4]. A 40-year-old car driver was involved in a road traffic accident with the seat belt buckled up. Clinical examination revealed an extensive tenderness on the skin over the posterior thoracic spine without neurological deficits. Computed tomography scanning of the cervicothoracic spine showed multiple thoracic Spinous Process fractures
Brian K Kwon - One of the best experts on this subject based on the ideXlab platform.
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association between degenerative spondylolisthesis and Spinous Process fracture after interSpinous Process spacer surgery
The Spine Journal, 2012Co-Authors: Nael Shanti, Mark Tantorski, Jeremy D Shaw, Juli F Martha, Ling Li, Stephen J Parazin, Adrian Thomas, Tal Rencus, Brian K KwonAbstract:Abstract Background context Spinous Process fracture is a recognized complication associated with interSpinous Process spacer (IPS) surgery. Although occasionally identified by plain radiographs, computed tomography (CT) appears to identify a higher rate of such fractures. Although osteoporotic insufficiency fracture is considered a contraindication for IPS surgery, a formal risk factor analysis for this complication has not previously been reported. Purpose To identify risk factor(s) associated with early Spinous Process fracture after IPS surgery. Study design/setting Prospective cohort study of 39 consecutive patients with lumbar stenosis and neurogenic claudication undergoing IPS surgery at a single institution. Methods Patients underwent preoperative dual-energy X-ray absorptiometry (DXA) scans, lumbar spine CT, and plain radiographs. Postoperatively, patients underwent repeat CT imaging within 6 months of surgery and serial radiographs at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. Preoperative CT scans were analyzed by calculating average Hounsfield units for a 1 cm 2 area of the midsagittal reconstructed image for four separate locations: midvertebral body, subcortical bone subjacent to the superior margin of the midSpinous Process, subcortical bone above the inferior margin of the midSpinous Process, and the midSpinous Process. Results Thirty-eight patients underwent IPS surgery at a total of 50 levels (38 L4–L5, 12 L3–L4; 26 one-level, 12 two-level). One patient underwent laminectomy at index surgery and was excluded from the analysis. Implants included 34 titanium X-STOP (Medtronic, Memphis, TN, USA), 8 polyaryletheretherketone X-STOP (Medtronic, Memphis, TN, USA), and 8 Aspen (Lanx, Broomfield, CO, USA) devices. Eleven Spinous Process fractures were identified by CT in 11 patients (22.0% of levels). No fractures were apparent on plain radiographs. The rate of spondylolisthesis observed on preoperative radiographs was 100% (11 of 11) among patients with fractures compared with 33.3% (9 of 27) of patients without fracture (p=.0001). Overall, 21 of 39 patients in this series had spondylolisthesis, and the rate of fracture in this group was 52%. Among patients without spondylolisthesis, the fracture rate was 0%. A trend was observed toward decreased DXA lumbar spine and hip T-scores among fracture patients versus nonfracture patients (0.2±1.7 vs. 0.8±1.7; p=.389; −1.1±1.4 vs. −0.3±1.4; p=.201), but these differences were not significant. Similarly, bone density based on CT measurements at four different locations revealed a trend toward decreased density among fracture patients, but these differences were not significant. Conclusions Degenerative spondylolisthesis appears strongly associated with the occurrence of Spinous Process fracture after IPS surgery. There is a trend toward increased fracture risk in patients with decreased bone mineral density as measured by both DXA scan and CT-based volume averaging of Hounsfield units, but osteoporosis appears to be a relatively weaker risk factor. The association between spondylolisthesis and fracture observed in this study may account for the relatively poorer outcome of IPS surgery in patients with spondylolisthesis that has been reported in previous series.
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occult Spinous Process fractures associated with interSpinous Process spacers
Spine, 2011Co-Authors: Mark Tantorski, Jeremy D Shaw, Juli F Martha, Ling Li, Nael Shanti, Tal Rencu, Stephen J Parazin, Brian K KwonAbstract:Study Design. Prospective observational study. Objective. To provide a more accurate estimate of the rate of acute Spinous Process fractures associated with IPS surgery. Summary of Background Data. Biomechanical cadaveric studies have suggested adequate Spinous Process strength to support placement of interSpinous Process spacers (IPS). Postoperative Spinous Process fractures have been reported in one%—to 5.8% of patients in previous series based on routine biplanar radiographic evaluation. However, most fractures occur between the base and midportion of the Spinous Process in an area that is typically difficult to visualize on plain radiographs due to device design. Methods. All patients underwent preoperative biplanar plain radiographs and computed tomography (CT) of the lumbar spine to confirm anatomy favorable for IPS placement and rule out fracture or spondylolysis. Postoperatively, all patients underwent repeat CT imaging within six months of surgery, biplanar radiographs at two weeks, six weeks, three months, six months, and one year. All studies were reviewed independently by a neuroradiologist and two orthopedic spine surgeons. Results. Fifty implants (38 L4–5, 12 L3–4) were placed in 38 patients who completed follow-up and were included in final analysis. Three IPS designs were included (34 Medtronic X-STOP titanium, 8 X-STOP PEEK, 8 Lanx Aspen). Postoperative CT revealed 11 nondisplaced Spinous Process fractures in 11 patients (28.9% of patients, 22% of levels). Five fractures were associated with mild to moderate lumbar back pain and six fractures were asymptomatic. No patient reported a traumatic incident. No fracture was identifiable on plain radiographs. One fracture displaced during follow-up evaluation. Three patients underwent IPS removal and laminectomy. Three fractures healed by CT in one year. Overall, patients with fractures tended toward poorer outcomes by Zurich Claudication Questionnaire (ZCQ) (28.5% vs. 34.8% improvement in symptom severity, P = 0.496; 21.4% vs. 30.7% improvement in physical function, P = 0.199) and tended toward lower satisfaction rates (50% vs. 73.7%, P = 0.24) at one year compared to patients without fracture. Conclusion. InterSpinous Process spacer surgery appears associated with a higher rate of early postoperative Spinous Process fracture than previously reported. In all cases, in this series, plain radiographs were inadequate to identify fractures because all fractures were initially minimal or nondisplaced, many patients were osteopenic, and the metallic wings of the devices often obscured fractures. Moreover, in most patients, fractures were associated with mild or no acute localized pain. This study suggests that unrecognized Spinous Process fracture may be responsible for a significant number of patients who experience unsatisfactory outcome after IPS surgery. CT imaging is required to identify the vast majority of such fractures.
Ali Akhaddar - One of the best experts on this subject based on the ideXlab platform.
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multiple isolated thoracic Spinous Process fractures clay shoveler s fracture
The Spine Journal, 2011Co-Authors: Ali Akhaddar, Abad Elasri, Mohamed BoucettaAbstract:Clay-Shoveler’s fracture is an isolated Spinous Process fracture typically observed in the lower cervical or upper thoracic spine [1]. Multiple involvements are rare [1–4]. A 40-year-old car driver was involved in a road traffic accident with the seat belt buckled up. Clinical examination revealed an extensive tenderness on the skin over the posterior thoracic spine without neurological deficits. Computed tomography scanning of the cervicothoracic spine showed multiple thoracic Spinous Process fractures
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Multiple isolated thoracic Spinous Process fractures (Clay-Shoveler’s fracture)
The Spine Journal, 2011Co-Authors: Ali Akhaddar, Abad Elasri, Mohamed BoucettaAbstract:Clay-Shoveler’s fracture is an isolated Spinous Process fracture typically observed in the lower cervical or upper thoracic spine [1]. Multiple involvements are rare [1–4]. A 40-year-old car driver was involved in a road traffic accident with the seat belt buckled up. Clinical examination revealed an extensive tenderness on the skin over the posterior thoracic spine without neurological deficits. Computed tomography scanning of the cervicothoracic spine showed multiple thoracic Spinous Process fractures
J Itoh - One of the best experts on this subject based on the ideXlab platform.
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Spinous Process-splitting laminoplasty using hydroxyapatite Spinous Process spacer.
Spine, 1992Co-Authors: K Nakano, S Harata, F Suetsuna, T Araki, J ItohAbstract:Between February 1986 and August 1989, 45 patients with cervical myelopathy were treated by Spinous Process-splitting laminoplasty. Hydroxyapatite intraSpinous spacers were used to maintain the enlargement of the cervical spinal canal. The shape of this spacer is trapezoidal. After sagittal splitting of the Spinous Process, the spacer was inserted between the two halves and affixed with the wire. Histologic study showed there was good fusion between the spacer and bone. In all cases, good enlargement of the cervical spinal canal was achieved. Spacer displacement, wire breakage, and postoperative infection were not seen. There was no postoperative neurologic deterioration. Computed tomography showed that the width of the cervical spinal canal was maintained.
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Spinous Process splitting laminoplasty using hydroxyapatite Spinous Process spacer
Spine, 1992Co-Authors: K Nakano, S Harata, F Suetsuna, T Araki, J ItohAbstract:Between February 1986 and August 1989, 45 patients with cervical myelopathy were treated by Spinous Process-splitting laminoplasty. Hydroxyapatite intraSpinous spacers were used to maintain the enlargement of the cervical spinal canal. The shape of this spacer is trapezoidal. After sagittal splittin
Moon Jun Sohn - One of the best experts on this subject based on the ideXlab platform.
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twelve contiguous Spinous Process fracture of cervico thoracic spine
Korean Journal of Spine, 2014Co-Authors: Moon Jun SohnAbstract:The clay-shoveler's fracture is an isolated avulsion fracture of the lower cervical or upper thoracic Spinous Process. Among them, multiple Spinous Process fractures are very rare. We present 34-year-old male patient who have multiple Spinous Process fractures with twelve contiguous levels of cervico-thoracic spine (from C4 to T8) after motorcycle accident. This case is multiple isolated Spinous Process fractures with good clinical outcome.
