Avulsion of the L4 spinous process: an unusual injury in a professional rugby player: case report.

Abstract

A case of L4 spinous process avulsion following a hyperflexion injury treated with surgical excision. To show that single photon emission computerized tomography is essential for the diagnosis and that excision can provide a successful outcome. The avulsion resulted from a forced hyperflexion injury at the L4/5 area, where the interspinous ligament provides a high resistance to flexion. 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. Initial conservative therapy failed to control the symptoms, and, therefore, late excision was performed with pain-free return to contact sports at 3 months. 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.