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Transverse Process Fracture

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Other Names

  • Cervical Transverse Process Fracture
  • Thoracic Transverse Process Fracture
  • Lumbar Transverse Process Fracture
  • TP Fracture (TPF)
  • Isolated Transverse Process Fracture (ITPF)

Background

  • This page describes transverse process fractures of the cervical, thoracic and lumbar spine

Epidemiology

  • More often single level (90%) than multiple level (10%) in the cervical spine[1]
  • Thoracolumbar TP fractures are more commonly multilevel (46%) than single level (44%)[2]
  • TP fractures of the lumbar spine represent the majority of lumbar spine injuries after blunt trauma at 48%[3]

Pathophysiology

  • Considered stable fractures
  • Istolated fractures do not involve lamina, pedicle or facets
  • Often extend into multiple segements

Etiology

  • Typically high energy blunt trauma from a motor vehicle accident or collision sport
  • Less commonly, falls, asasult, penetrating injury, crush injury, bicycle accident
  • Isolated TP fractures due to MVC more common in chikdren than adults
  • Isolated TP fractures due to falls more common in adults
  • Can be seen in the setting of extreme rotation and/or side bending

Pathoanatomy

  • Transverse Process
    • Attaches to Vertebrae
    • Projects laterally from region where pedicle meets lamina
    • In upper 6 cervical spinal levels, the Vertebral Artery passes through the transverse foramen
    • Thoracic and lumbar TPs do not have a transverse foramen

Associated Injuries

  • Cervical TP fracture
  • Thoracolumbar TP fracture
    • Abdominal injuries
    • Pediatric thoracic TP fractures has a 70% correlation with head or chest injury, 20% with abdominal[4]
    • Pediatric lumbar TP fractures correlate with chest (41%), head (30%) injuries

Risk Factors

  • Unknown

Differential Diagnosis

Differential Diagnosis Neck Pain

Differential Diagnosis Back Pain


Clinical Features

  • General: Physical Exam Neck, Physical Exam Back
  • History
    • Typically report a history of blunt trauma
  • Physical Exam
    • Point tenderness at the site of fracture
    • In cervical spine, complete neuro exam is important

Evaluation

Radiographs

  • Standard C spine films may be indicated
    • Sensitivity is not great
  • May be missed on up to 11% of patients undergoing evaluation after trauma[5]

CT

  • More sensitive
  • Indicated in the setting of trauma

Classification

  • N/A

Management

Prognosis

  • As isolated injuries, patients have an excellent prognosis
  • One study reported 100% of patients neurologically intact at presentation which was preserved at 19 months followup[4]
  • A second study found cervical range of motion and mean neck disability index to be normal at 27 months follow up[6]
  • Approximately 1% report persistent TP fracture related back pain[7]

Nonoperative

  • Standard treatment is conservative
  • Some studies event suggest no specific treatment or restrictions
  • Pain management including NSAIDS, Acetaminophen and Opiates
  • Muscle relaxers are commonly prescribed
  • Bracing with Cervical Collar, Corset]] for comfort
    • Not intended to stabilize the spine
    • No evidence that these devices promote healing, prevent worsening of injuries

Operative

  • None

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play

  • Needs to be updated

Complications


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:E965-E970.
  2. Patten RM, Gunberg SR, Brandenburger DK. Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal ct in patients with trauma. Radiology. 2000;215:831-834.
  3. Holmes JF, Miller PQ, Panacek EA, Lin S, Horne NS, Mower WR. Epidemiology of thoracolumbar spine injury in blunt trauma. Acad Emerg Med. 2001;8:866-872.
  4. 4.0 4.1 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; 17:639-644
  5. . Krueger MA, Green DA, Hoyt D, Garfin SR. Overlooked spine injuries associated with lumbar transverse process fractures. Clin Orthop Relat Res. 1996:191-195
  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:E965-E970
  7. r JH, Lovasik BP, Baum GR, Frerich JM, Allen JW, Grossberg JA, et al. Implications of isolated transverse process fractures: is spine service consultation necessary? World Neurosurg. 2016;95:285-291.
Created by:
John Kiel on 4 July 2019 09:28:46
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Last edited:
3 December 2020 06:00:30
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