Spine Case 13 Management

Isolated Clay Shoveler fractures are stable injuries. They typically present without further ligamentous, neurologic, or bony injury. ED management is focused on symptom control. Nonoperative treatment consists of pain control, rest, and short-term immobilization with a soft neck collar for comfort until symptomatic improvement. Most people can return to normal activities within a month as guided by symptoms. However, if neurologic signs are present, the provider should pursue further evaluation with vessel imaging or MRI scans of the cervical spine to evaluate for ligamentous or cord injury.

Operative management and neurosurgical consultation for removal of the spinous fragment can be considered for repeat ED visits due to persistent pain, failure of conservative treatment, or non-union.