Isolated transverse process fracture: Difference between revisions
 
(6 intermediate revisions by the same user not shown)
Line 3: Line 3:
*Are not associated with any ligamentous or structural injury that can contribute to spinal instability or spinal cord compromise.  
*Are not associated with any ligamentous or structural injury that can contribute to spinal instability or spinal cord compromise.  
*Systematic literature review reveals 819 documented cases, with none requiring surgical intervention<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref><ref>Homnick A, Lavery R, Nicastro O, Livingston DH, Hauser CJ. Isolated thoracolumbar transverse process fractures: call physical therapy, not spine. J Trauma. 2007; 63(6): 1292-5.</ref><ref>Akinpelu BJ, Zuckerman SL, Gannon SR, Westrick A, Shannon C, Naftel RP. Pediatric isolated thoracic and/or lumbar transverse and spinous process fractures. J Neurosurg Pediatr. 2016: 1-6.</ref>
*Systematic literature review reveals 819 documented cases, with none requiring surgical intervention<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref><ref>Homnick A, Lavery R, Nicastro O, Livingston DH, Hauser CJ. Isolated thoracolumbar transverse process fractures: call physical therapy, not spine. J Trauma. 2007; 63(6): 1292-5.</ref><ref>Akinpelu BJ, Zuckerman SL, Gannon SR, Westrick A, Shannon C, Naftel RP. Pediatric isolated thoracic and/or lumbar transverse and spinous process fractures. J Neurosurg Pediatr. 2016: 1-6.</ref>
{{Vertebral fractures and dislocations types}}


==Clinical Features==
==Clinical Features==
Line 8: Line 10:


==Differential Diagnosis==
==Differential Diagnosis==
{{Cervical spine injuries}}
{{Blunt neck trauma DDX}}
{{Thoracic trauma DDX}}
{{Lower back pain DDX}}


==Evaluation==
==Evaluation==
[[File:PMC2776377 JETS-02-217-g001.png|thumb|Lumbar spine antero-posterior x-ray showing fractures of left L2 and L3 transverse processes (arrows).]]
===Workup===
===Workup===
*CT scan (gold standard)
*CT scan (gold standard)
Line 24: Line 29:
**Immobilization via cervical collar, brace (e.g. TLSO), halo vest is '''not''' necessary
**Immobilization via cervical collar, brace (e.g. TLSO), halo vest is '''not''' necessary
***May hinder patient recovery (e.g. inhibit pulmonary function, increase intracranial pressure, pressure sores, increased medical costs)  
***May hinder patient recovery (e.g. inhibit pulmonary function, increase intracranial pressure, pressure sores, increased medical costs)  
*Subaxial cervical spine (C3-C7) without involvement of the transverse foramen, thoracic, or lumbar spine do '''not''' require spine specialist consult (e.g. neurosurgery, orthopedics)<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref>
*The following types do '''not''' require spine specialist consult (e.g. neurosurgery, orthopedics):<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref>
**Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.
**Subaxial cervical spine (C3-C7) without involvement of the transverse foramen
***Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.
**Thoracic (all)
**Lumbar (all)


===Pediatric Patients (<15 years old)===
===Pediatric Patients (<15 years old)===

Latest revision as of 21:55, 19 October 2022

Background

  • Defined as those involving the transverse process only, without extension into the pedicle, lamina, or facet complex.
  • Are not associated with any ligamentous or structural injury that can contribute to spinal instability or spinal cord compromise.
  • Systematic literature review reveals 819 documented cases, with none requiring surgical intervention[1][2][3][4]

Vertebral fractures and dislocations types

Vertebral anatomy.
Numbering order of vertebrae.

Clinical Features

  • Pain over spine

Differential Diagnosis

Neck Trauma

Thoracic Trauma

Lower Back Pain

Evaluation

Lumbar spine antero-posterior x-ray showing fractures of left L2 and L3 transverse processes (arrows).

Workup

  • CT scan (gold standard)
  • Consider additional trauma workup, as transverse process fractures may be indicators of other more serious injuries

Evaluation

  • Diagnosed typically on CT

Management

Adults (>15 years old)

  • Pain management, early mobilization, and unrestricted movement
    • Do not require surgical intervention
    • Immobilization via cervical collar, brace (e.g. TLSO), halo vest is not necessary
      • May hinder patient recovery (e.g. inhibit pulmonary function, increase intracranial pressure, pressure sores, increased medical costs)
  • The following types do not require spine specialist consult (e.g. neurosurgery, orthopedics):[5][6]
    • Subaxial cervical spine (C3-C7) without involvement of the transverse foramen
      • Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.
    • Thoracic (all)
    • Lumbar (all)

Pediatric Patients (<15 years old)

  • Same as for adults, except only thoracolumbar spine fractures do not require spine specialist (e.g. neurosurgery, orthopedics) consultation[7]

Disposition

  • Outpatient care

See Also

External Links

References

  1. ↑ Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.
  2. ↑ Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.
  3. ↑ Homnick A, Lavery R, Nicastro O, Livingston DH, Hauser CJ. Isolated thoracolumbar transverse process fractures: call physical therapy, not spine. J Trauma. 2007; 63(6): 1292-5.
  4. ↑ Akinpelu BJ, Zuckerman SL, Gannon SR, Westrick A, Shannon C, Naftel RP. Pediatric isolated thoracic and/or lumbar transverse and spinous process fractures. J Neurosurg Pediatr. 2016: 1-6.
  5. ↑ Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.
  6. ↑ Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.
  7. ↑ Akinpelu BJ, Zuckerman SL, Gannon SR, Westrick A, Shannon C, Naftel RP. Pediatric isolated thoracic and/or lumbar transverse and spinous process fractures. J Neurosurg Pediatr. 2016: 1-6.
Retrieved from "https://www.wikem.org/w/index.php?title=Isolated_transverse_process_fracture&oldid=366865"