title: "Spinolaminar breach": an important sign in cervical spinous process fractures.
abstract: OBJECTIVE
  To report the sign of "spinolaminar breach" and its likely importance in fractures of the cervical spinous processes.
  
  
  METHODS
  Six cases of spinous process fractures demonstrating disruption of the spinolaminar line or "spinolaminar breach" were analyzed. Lateral and anteroposterior radiographs (n=6), CT scans (n=3) and MRI scans (n=1) were reviewed together by the authors, with consensus being reached as to the radiographic findings. Clinical records were also reviewed.
  
  
  RESULTS
  The levels of injury were C6 (n=5) and C5 (n=2). Injuries were associated with delayed anterior subluxation (n=4) and neurological deficit (n=2). Five patients were male and one was female with a mean age of 31 years (range 8-59 years). Injuries resulted from motor vehicle accidents (n=4), a motor cycle accident (n=1) and a fall (n=1).
  
  
  CONCLUSIONS
  "Spinolaminar breach", or disruption of the spinolaminar line, indicates a complex spinous process fracture with extension into the lamina and spinal canal. Spinous process fractures with spinolaminar breach may have associated posterior ligamentous injury with potential for delayed instability and neurological deficit. It is important that radiologists and physicians caring for the trauma patient be aware of this sign in order to avoid misdiagnosis as a "clay shoveler's fracture", which can lead to adverse outcome.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Matar
authors.forename: C A
authors.initials: CA
authors.lastname: Helms
authors.forename: W J
authors.initials: WJ
authors.lastname: Richardson
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed