Avulsion of the L4 spinous process: an unusual injury in a professional rugby player: case report.
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.
Jones
Alwyn
A
University of Wales Hospital, Heath Park, Cardiff, United Kingdom. alwyn.j@virgin.net
Andrews
John
J
Shoaib
Amer
A
Lyons
Kath
K
Ahuja
Sashin
S
Howes
John
J
Davies
Paul
P
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