title: Avulsion of the L4 spinous process: an unusual injury in a professional rugby player: case report.
abstract: METHODS
  A case of L4 spinous process avulsion following a hyperflexion injury treated with surgical excision.
  
  
  OBJECTIVE
  To show that single photon emission computerized tomography is essential for the diagnosis and that excision can provide a successful outcome.
  
  
  BACKGROUND
  The avulsion resulted from a forced hyperflexion injury at the L4/5 area, where the interspinous ligament provides a high resistance to flexion.
  
  
  METHODS
  A 29-year-old international rugby football player injured his low back during a match. Plain radiography and magnetic resonance imaging did not reveal the injury. Single photon emission computerized tomography and computerized tomography showed the lesion.
  
  
  RESULTS
  Initial conservative therapy failed to control the symptoms, and, therefore, late excision was performed with pain-free return to contact sports at 3 months.
  
  
  CONCLUSIONS
  Few cases of interspinous process avulsions have been described, and, to our knowledge, this is the first reported case of rugby football player who had a successful outcome with late surgical excision.
authors.affiliation: University of Wales Hospital, Heath Park, Cardiff, United Kingdom. alwyn.j@virgin.net
authors.forename: Alwyn
authors.initials: A
authors.lastname: Jones
authors.forename: John
authors.initials: J
authors.lastname: Andrews
authors.forename: Amer
authors.initials: A
authors.lastname: Shoaib
authors.forename: Kath
authors.initials: K
authors.lastname: Lyons
authors.forename: Sashin
authors.initials: S
authors.lastname: Ahuja
authors.forename: John
authors.initials: J
authors.lastname: Howes
authors.forename: Paul
authors.initials: P
authors.lastname: Davies
mesh_terms: D000328:Adult; D005538:Football / Q000293:injuries*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D016103:Spinal Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome