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Cervical Syrinx with Chiari I
Joseph Junewick, MD FACR
over 8 years ago
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Spinous Process Apophyseal Avulsion

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 8 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: CT MR NM
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Teenage female gymnast with neck pain.

Case Images


Spinous Process Apophyseal Avulsion of C7


CT – Sagittal reformatted image shows subtle separation of the apophysis of the spinous process of C7.

MR – Sagittal inversion recovery image shows edema in the C7 spinous process.

NM – Sagittal SPECT image from Tc-99m methylene diphosphonate bone scan shows changes of injury/healing.


Clay shoveler’s fracture affects the spinous process of the lower cervical and upper thoracic spine. Acute or chronic repetitive deceleration forces caused by the pull of the trapezius, rhomboids, and the ligamentum nuchae on the neck exert traction on their attachment to the spinous processes. In children this may be manifest as an apophyseal avulsion injury – the so called pediatric equivalent clay shoveler’s injury.


Yamaguchi KT, Myung KS, Alonso MA et al. Clay-Shoveler’s Fracture Equivalent in Children. Spine (2012); 37:E1672-E1675.

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