In the third case, here reported, the fracture involved the spinous process of T-l. In two of these the diagnosis of fracture of the spinous process of C-7 was made on the preliminary anteroposterior view. Under such circumstances, the anteroposterior view of the spine should be sufficient to make a diagnosis of fracture.ĭuring the past twelve months this x-ray sign of fracture of the spinous processes of the lower cervical and upper thoracic vertebrae has been observed in three cases. On the routine lateral view of the neck it is difficult to see the spinous processes of C-7 and T-l because of the superimposition of the shadows produced by the bone and soft tissues of the shoulder girdle. Patients who have received a severe head or neck injury usually report to the hospital with the head held either in hyperflexion or hyperextension. A smooth, crescentic area of decreased density represents the fractured base of the spinous process, and a denser shadow lying in the soft tissues, slightly caudad to the base of the spinous process, represents the displaced tip. On the x-ray film, a double shadow is seen. The fracture can be identified by the malalignment and downward displacement of the outer end of the spinous process.
The radiographic diagnosis of fractures of the spinous processes of the seventh cervical and the first thoracic vertebra can be made on the preliminary anteroposterior view of the cervical and upper thoracic spine. On the anteroposterior view they are recognized only with difficulty, unless especially sought. Spinous process fractures are most readily seen on the lateral view.
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