Isolated transverse process fractures

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

Cervical Spine Fracture and Dislocation Types

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)
  • 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


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.
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