Multiple Cervical Spinous Process Fractures in a Novice Golf Player
A 45-year-old female presented with intractable posterior neck pain that had lasted for 11 days. The severity of the pain had prevented sleep and rotation of the neck for 7 days. The patient had experienced a sharp and sudden pain on the posterior neck during a golf swing. The pain began when the club contacted the ground instead of the golf ball. Under the impression of acute sprain, the patient was treated conservatively at the local hospital. But, the symptom was aggravated despite receiving massage and physical therapy. There was no notable history of medical illness, such as diabetes, hypertension and osteoporosis. On physical examination, the patient complained of severe tenderness over the lower mid-cervical area and, in particular, limited range of motion during flexion and extension. However, swelling and ecchymosis were not evident at the tender point. The findings of neurological symptoms and signs were normal. Dynamic cervical radiographic findings were fractures in the spinous processes of C6 and C7 vertebrae without instability (). The patient underwent cervical magnetic resonance imaging (MRI) with a suspicion of other occult trauma around C6 and C7. Sagittal T1 and T2-weighted images () also showed spinous process fractures in C6 and C7. There was no abnormalitiy in the spinal cord. Fat saturation image () revealed high signal areas in interspinous and supraspinous ligaments between the C6 and C7 vertebra suggestive of an acute injury to cervical spine. Under the diagnosis of stable C6 and C7 spinous process fractures, the patient was prescribed with pain medications and wearing a cervical collar was recommended for 6 weeks. After cervical bracing and medication, pain gradually improved.