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Isolated thoracolumbar spine transverse process fractures do not undermine the integrity of the three-column vertebral support system, but they are associated with structurally unstable thoracolumbar spine fractures in 10% to 20% of patients. Plain radiographs miss these unstable thoracolumbar bony injuries in about 10% of cases. In a retrospective study of trauma-registry data, researchers analyzed characteristics of isolated thoracolumbar transverse process fractures discovered by 16-slice computed tomography (CT) at a single level I trauma center between 2002 and 2005.
Of 314 patients with thoracolumbar transverse process fractures, 248 had isolated fractures. In the group with isolated fractures, 72% were male, 89% sustained blunt mechanisms of injury, and the mean Injury Severity Scale score was 19. Forty-four percent of patients had one thoracolumbar transverse process fracture, 21% had two, 14% had three, 12% had four, and 9% had five to nine fractures. Visceral chest injuries were present in 29% of patients, abdominal injuries in 28%, chest and abdominal injuries in 11%, and pelvic fractures in 33%. Spine consultation and follow-up did not result in the discovery of any new thoracolumbar fractures or neurological damage, and no further studies were required.
Homnick A et al. Isolated thoracolumbar transverse process fractures: Call physical therapy, not spine. J Trauma 2007 Dec; 63:1292.
Comment
This study demonstrates that thoracolumbar transverse process fractures reflect significant torso trauma and are associated with a considerable incidence of intra-abdominal and pelvic injuries. Although the study cohort was relatively small, the findings suggest that, particularly with today’s higher-resolution 128- and 256-slice scanners, isolated thoracolumbar transverse process fractures identified by CT do not require neurosurgical or orthopedic consultation, log-roll precautions, or additional imaging.