Isolated transverse process fracture: Difference between revisions
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*Pain management, early mobilization, and unrestricted movement | *Pain management, early mobilization, and unrestricted movement | ||
**Do '''not''' require surgical intervention | **Do '''not''' require surgical intervention | ||
**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) | ||
nor | nor | ||
*Subaxial cervical spine (C3-C7) without involvement of the transverse foramen, thoracic, or lumbar spine do '''not''' require spine specialist (e.g. neurosurgery, orthopedics) consultation<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> | *Subaxial cervical spine (C3-C7) without involvement of the transverse foramen, thoracic, or lumbar spine do '''not''' require spine specialist (e.g. neurosurgery, orthopedics) consultation<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. | **Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult. | ||
===Pediatric Patients (<15 years old)=== | ===Pediatric Patients (<15 years old)=== | ||
Revision as of 15:45, 3 June 2019
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]
Clinical Features
- Pain over spine
Differential Diagnosis
Vertebral fractures and dislocations types
- Cervical fractures and dislocations
- Thoracic and lumbar fractures and dislocations
Evaluation
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)
nor
- Subaxial cervical spine (C3-C7) without involvement of the transverse foramen, thoracic, or lumbar spine do not require spine specialist (e.g. neurosurgery, orthopedics) consultation[5][6]
- Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.
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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.