Atlantooccipital fusion or occipitalization or assimilation of the atlas is a rare congenital anomaly demonstrated in anatomical, radiological, and morphological studies. Clay-shoveler\'s fracture, which is an isolated multiple fracture of the cervical and thoracic vertebrae, and this fusion association is extremely rare and we had an opportunity to understand the mechanism of Clay-shoveler\'s fracture.

A 58 years-old female patient was admitted to the emergency department due to a hyperflexion injury as a result of a traffic accident. Multiple spinous process fractures were detected at the C3-C5-C6-T1-T2-T3-T4 levels on computed tomography images. In addition, there was an image of atlantooccipital assimilation at the craniovertebral junction.

Multiple levels spinous process fractures are extremely rare lesions that occur as a result of direct trauma or repetitive traction. They are usually conservative without the need for surgery. However, as in our case, a more detailed neuroradiological examination should be performed to detect accompanying incidental anomalies or more serious spinal traumas.