• Josh E Schroeder, Leon Kaplan, Amir Hasharoni, Nurit Hiller, and Yair Barzilay.
• Department of Orthopedic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
• Spine. 2009 Nov 1; 34 (23): E864-5.

Study DesignA case of an isolated lumbarized S1 spinous process fracture due to direct trauma from a fall on the lower back is reported here. The patient was treated nonoperatively. Pain subsided and he returned to every day.ObjectiveTo alert physicians of this rare fracture as part of the differential diagnosis in cases of direct trauma to the lower spine. The method of diagnosing such pathology and its treatment are described.Summary Of Background DataA 22-year-old man was admitted with lower back pain after falling down a flight of stairs during which, he sustained a direct blow to his lower back. The patient had a scrape over L5-S1 area and midline tenderness around the L5-S1 area. He was neurologically intact. Radiographs revealed a lumbarized S1 vertebra and an isolated fracture of the spinous process of S1. The fracture resulted from the direct trauma to the S1 lumbarized vertebrae. The direct trauma and the fact that the patient has a lumbarized S1 vertebra with a thin spinous process contributed to the fragility of the spinous process.MethodsNonoperative measures, physical therapy, primarily analgesics, and local heat, were employed.ResultsThe patient returned to his normal routine after 3 weeks.ConclusionsFew cases of isolated spinous process fractures have been described, and, to our knowledge, this is the first reported case of an isolated fracture of a lumbarized S1 spinous process to due to direct trauma. Radiograph imaging was adequate to determine the extent of the injury. Nonoperative treatment can allow the patient to return to every day life without the need of surgery.

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