Transverse process is a bony protrusion from the posterior aspect of the vertebra. Every cervical, thoracic and lumbar vertebra has a transverse process on either side. Although transverse process fractures (TPF) are considered minor spinal injuries, they occur as a result of major force and are often related to other serious injuries. Cervical transverse process fractures frequently appear in the context of other cervical spine fractures [1], vertebral artery dissection and blunt cerebrovascular injury (BCVI) while 35% patients with lumbar transverse process fractures have intraabdominal (hepatic, splenic, genitourinary and diaphragmatic) injuries [2]. Lumbar TPF are more common, involve the upper lumbar spine and are usually multiple [1]. They can occur as a result of blunt trauma e.g during motor vehicle accidents; violent lateral flexion-extension injuries e.g. during football or other sports; avulsion injury of the psoas muscle; or Malgaigne fractures of the pelvis.[3] [4] [5]. Although TPF have been reported to be associated with visceral injuries [2] [4], they can also occur in the absence of other vertebral and visceral injuries [6].

Patients usually present with sudden onset of severe pain following the injury with decreased range of motion in the region of the affected part of the spine. The pain may be aggravated with movement and there may be swelling and tenderness around the fracture site. If there are visceral injuries, patients may present with features of hypovolemic shock. Patients with isolated transverse process fractures do not present with neurological deficits.

• Pain

  Pain Pract. 2014 Nov;14(8):752-6. doi: 10.1111/papr.12213. Epub 2014 Apr 21. Author information 1 Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Korea. [ncbi.nlm.nih.gov]

  The trigger point will be painful if pressed and may cause referred pain (e.g. pressing in at one point causes pain somewhere else). [sportsinjuryclinic.net]

  […] legs Pain and swelling in either leg Loss of control over bowels or bladder, or numbness in the groin (or genital area) Chest pain or shortness of breath Back pain that spreads to one or both legs © 2000-2018 The StayWell Company, LLC. 800 Township Line [fairview.org]

  For Romo, a decision on playing will likely come down to how he is able to tolerate the pain. If the injury is limited to a break of a transverse process with no other bone or organ injury, hospital care may not be necessary. [fansided.com]

  But, that roll over was where I experienced the most pain of the ordeal once I made it home from the initial accident. Knowing the pain was coming, I would just get rolled over and deal with it. [m4carbine.net]

• Falling

  Of course, anyone – even those of us who aren’t professional athletes – can fall victim to the same injury. Transverse process fractures can happen from bad falls or vehicle accidents, for example. [mccancemd.com]

  Abstract We present a case of multilevel lumbar transverse process fracture in a professional association football player, incurred after a fall from height during competitive play. [academic.oup.com]

  Use your cane or walker if you have difficulty walking or an increased risk for falls. How can I prevent a transverse fracture? Transverse fractures are usually caused by falls or other accidents that are hard to prevent. [my.clevelandclinic.org]

  My most recent case involving this type of fracture resulted from a patient falling off a horse into a ditch. [body-motion.co.uk]

  If the fracture falls through the disks of the spine, surgery will be required to stabilize it. [shorelineortho.com]

• Inflammation

  This fracture is painful and causes inflammation and damage to the surrounding tissue – but it will not mean the end of a career for Tony Romo. [thespinehealthinstitute.com]

  Engelsk definition Inflammation of a transverse portion of the spinal cord characterized by acute or subacute segmental demyelination or necrosis. [mesh.kib.ki.se]

  Even a small transverse process fracture can be incredibly painful, causing severe inflammation in the surrounding tissue and back spasms. The swelling and spasms can limit mobility, though this injury usually doesn’t require surgery. [mccancemd.com]

  That is why he/she gave you antiinflammatory medication, to reduce the inflammation in those joints. Since the transverse processes are surrounded by muscles, they usually heal readily. [ehealthforum.com]

  Arthritis of the knee is a condition that causes inflammation, pain, swelling and limited movement of the knee joint and connective tissues around the knee. [northwell.edu]

• Surgical Procedure

  Surgical Procedure The ultimate goal of surgical treatment for fracture of the thoracic and lumbar spine is to achieve adequate reduction (fitting the bones together), relieve pressure on the spinal cord and nerves, and allow for early movement. [shorelineortho.com]

  During this non-surgical procedure, your provider will physically push and pull your body on the outside to line up the broken bones inside you. [my.clevelandclinic.org]

  […] of one of these procedures. [physio-pedia.com]

• Disability

  Please enable JS and disable any ad blocker [lequotidiendumedecin.fr]

  […] radiographs, a patient satisfaction of 9.3 (SD 1.48), a Cybex measured range of motion in the sagittal plane of 109 degrees (SD 12.5, 95-129), the frontal plane of 70 (SD 17.8, 37-100) and the transverse plane of 144 (SD 12.5, 116-164), and a mean neck disability [neurosurgery.directory]

  Differential Diagnosis Coxxyx pain = Disabling pain in and around the coccyx that may radiate to the lumbar spine. Physical examination of lumbar spine (is normal in case of coccyx pain).25 Only pressure point pain is present. [physio-pedia.com]

  The degree of instability depends on several factors that may translate into neurologic disability, secondary to spinal cord compression. [emedicine.medscape.com]

• Pneumonia

  With a minimally invasive approach, patients are less likely to experience dangerous symptoms caused by inactivity—like pneumonia. [youtube.com]

  The major complication to fear is pneumonia, when areas of the lung do not expand and aerate, making them prime targets for infection. Another issue has to do with damage to the abdomen. [mddirect.org]

  Complications There are several complications associated with fractures of the thoracic and lumbar spine, including pneumonia and pressure sores. [shorelineortho.com]

  Complications associated with fractures of the thoracic and lumbar spine include: Blood clots in the pelvis and legs—these may develop during long periods of bed rest or immobility Pulmonary embolism—a blood clot that breaks free and travels to the lungs Pneumonia [orthoinfo.aaos.org]

• Thrombosis

  Early mobilization will help improve functionality while also reducing the risk of developing deep vein thrombosis, along with its sequelae. Our study is not without limitations. [thejns.org]

• Ulcer

  Ulcers. Stomach pain. Bowel complications. [my.clevelandclinic.org]

• Fracture

  "He got several tests, and the last one came back (showing a fracture)." Carr is the team's unquestioned leader, its public face. Losing him for any stretch is a setback to a scuffling Raiders offense and the team as a whole. [nbcbayarea.com]

  Seven (12%) of the 28 patients with a stable fracture pattern had an associated L5 transverse process fracture. Three patients (2%) had an L5 transverse fracture in the absence of a demonstrable pelvis fracture. [ncbi.nlm.nih.gov]

  fracture C1 isolated anterior arch fracture C1 isolated posterior arch fracture C2 Odontoid fracture Hangman's fracture C3-C7 Cervical burst fracture Cervical spinous process fracture Extension cervical teardrop fracture Flexion cervical teardrop fracture [wikem.org]

  TP Fracture Level The 58 casualties with isolated TP fractures sustained a total of 165 isolated TP fractures. The distribution of isolated TP fractures across the spine is shown in Figure 2. [journals.lww.com]

  Transverse process fracture is a rare and stable fracture of the spine. It occurs as a result of sudden and extreme trauma. [symptoma.com]

• Back Pain

  Significant leg pain that came on after experiencing severe back pain. Referred pain into the legs and/or feet following a back injury, especially if the symptoms do not decrease within 24 hours. [sportsinjuryclinic.net]

  Case A 35-year-old male elite player presented with back pain after being hit on his left lower back during a match. He could not play the next game due to intense back pain. [fifamedicalnetwork.com]

  If you are suffering from back pain as the result of an injury or accident, call Dr. Chetan Patel at the Spine Health Institute. He can get you back in the game in no time. [thespinehealthinstitute.com]

  I have enormous back pain which which varies from my mid-lower back to the entire length of my back. [medhelp.org]

• Osteoporosis

  Osteoporosis is a leading cause of pathologic fracture. People with osteoporosis have bones that have become brittle or weak, causing them to break easier than healthy bones. [pbmchealth.org]

  While some fractures are very serious injuries that require emergency treatment, other fractures can be the result of bones weakened by osteoporosis. [orthoinfo.aaos.org]

  Women, people assigned female at birth and adults older than 50 have an increased risk for developing osteoporosis. Talk to your provider about a bone density screening that can catch osteoporosis before it causes a fracture. [my.clevelandclinic.org]

  #6 Dexa and bisphosphonates or Forteo, depending on how low his T score is decadron will make the osteoporosis worse, so should be avoided [forums.studentdoctor.net]

  Things that may increase the chance of a spinous process fracture are: Having health problems that weaken bones, such as osteoporosis Low muscle mass Playing sports that involve sudden twists and turns or extreme contact Not wearing a seatbelt Being around [winchesterhospital.org]

• Muscle Spasm

  He said he had muscle spasms in his back but felt optimistic about playing in Week 5 after the game, noting that an MRI would be needed. Now we know that an MRI showed something more than just muscle spasms. [sportsnaut.com]

  In addition, diazepam was prescribed as a muscle relaxant after the development of lower back muscle spasm 2 days post-trauma. [academic.oup.com]

  I get what feels like sciatica and then serious muscle spasms which I can stretch out if I catch in time. Also, I am having, at least for the last two years, an awful pain in my lower left side. A gastroenterologist is looking into it. [healthboards.com]

  There will be pain when bending and twisting, muscle spasm and stiffness in the back. The area may be tender to touch over the area of injury and there may be some swelling. [sportsinjuryclinic.net]

• Low Back Pain

  Low back pain – should I see a doctor? Most low back injuries will settle down with appropriate rest and treatment. However, some require further assessment and professional treatment. [sportsinjuryclinic.net]

  However, he was complaining of low back pain, non-radiating and minimal relief with analgesics. An MRI of the dorso-lumbar spine was performed and it was normal. [joas.in]

  The low back pain in the athletes (especially following stress fractures of vertebrae) is described as crescendo-type pain [8] that typically occurs towards the end of the bowling spell initially, progressing gradually, occuring at an earlier time as [bmcsportsscimedrehabil.biomedcentral.com]

  Mechanical Low Back Pain (= Non-Specific Low Back Pain) = Any type of back pain in the lumbar region that is not related to serious pathology or does not have a specific cause. [physio-pedia.com]

• Distractibility

  However the distraction is the most important finding, i.e. distraction and PLC injury, i.e. 4+3 points. So here is a typical case of distraction. The primary feature is pulling apart. There is not much else happening here. [radiologyassistant.nl]

  The neurological examination was normal, and computed tomography (CT) imaging revealed multiple fractures at right transverse processes from L1 to L5, a single left-sided transverse process fracture at L2 and subtle facet joint distraction without other [miami.pure.elsevier.com]

  Flexion-distraction / 'Chance' fracture - Lateral Hover on/off image to show/hide findings Tap on/off image to show/hide findings Click image to align with top of page Flexion-distraction / 'Chance' fracture - Lateral All three columns are disrupted A [radiologymasterclass.co.uk]

  There is a distractive force which causes the posterior column to fail in tension, and the anterior column fails in distraction or compressive flexion. Patients should be assessed for visceral/abdominal and head injuries. [posna.org]

  Extension Fracture Pattern Flexion/distraction (Chance) fracture—The vertebra is literally pulled apart (distraction); this can occur in accidents such as a head-on collision, where the upper body is thrown forward while the pelvis is stabilized by a [shorelineortho.com]

• Tingling

  They may cause: Severe pain that may be worse when moving Swelling and bruising Numbness, tingling, or weak muscles Problems moving the injured part of the spine Loss of bladder or bowel control Diagnosis The doctor will ask about your symptoms and health [winchesterhospital.org]

  Neural symptoms such as numbness, tingling and weakness may be present along with bladder or bowel symptoms depending on how the fracture is pressing onto the spinal cord. [sportsinjuryclinic.net]

  Spinous process fractures can produce an array of symptoms, including: Back pain Decreased ability to turn or bend their back A 'crunch' sound when moving, bending or twisting their back Numbness or tingling radiating from where the fracture occurred [study.com]

  NEUROLOGIC: No loss of consciousness, numbness, tingling or weakness. PAST MEDICAL HISTORY: None. PAST SURGICAL HISTORY: Vasectomy MEDICATIONS: NONE ALLERGIES: None. SOCIAL HISTORY: Denies alcohol, tobacco, and illicit drug abuse. [drhem.wordpress.com]

• Sciatica

  Sciatica Sciatica is a symptom, not a diagnosis of a particular injury. Sciatica pain usually, but not always starts with acute low back pain which radiates into the buttocks, back of the thigh and legs. [sportsinjuryclinic.net]

  I get what feels like sciatica and then serious muscle spasms which I can stretch out if I catch in time. Also, I am having, at least for the last two years, an awful pain in my lower left side. A gastroenterologist is looking into it. [healthboards.com]

• Paresthesia

  At follow-up, all 69 patients were neurologically intact, although 1 patient complained of lingering paresthesias in the fingertips that has improved since injury. [thejns.org]

  “Pins and needles” (paresthesia) feeling or “loss of feeling” (anaesthesia) in the legs or feet. [sportsinjuryclinic.net]

Transverse process fractures are known to occur after high-velocity trauma and therefore all patients must be evaluated thoroughly for the presence of serious visceral injuries [3] [4] [7]. After eliciting the history of the type of injury, the physician should examine the cervical, thoracic and lumbar spine and abdominopelvic region followed by a detailed neurological evaluation. Laboratory tests are not helpful in diagnosis but can help to evaluate comorbid medical conditions. So complete blood count, blood sugar, serum chemistries, blood grouping, cross matching and urinalysis depending on the clinical presentation should be ordered. Urinalysis can help to identify renal injury while elevated amylase levels may be an indication of pancreatic injury and elevated cardiac markers can indicate cardiac contusion.

Conventional radiographs are not very helpful as they are frequently unable to detect TPF and concomitant visceral injuries in the emergency setting in the presence of bowel gas [1] [3] [8]. Computed tomography is, therefore, the investigation of choice as it can identify TPF successfully, as well as related visceral injuries [1] [4] [9]. Magnetic resonance imaging may be required if spinal cord trauma is suspected.

This report introduces a method of active treatment to help patients with LSTPFs quickly return to their daily lives and professional activities. [ncbi.nlm.nih.gov]

Treatment progresses as pain subsides, meaning you can begin to take on more activity as discomfort fades. [sinicropispine.com]

However, none of these patients received treatment for the TPF. [neurosurgery.directory]

Confidently approach every form of traumatic injury with current coverage of relevant anatomy and biomechanics, mechanisms of injury, diagnostic approaches, treatment options, and associated complications. [books.google.com]

An x-ray is the first step in treatment, but usually the diagnosis is confirmed with a CT scan of the spine which is best at showing bony structures. [theinjurysource.com]

Additionally, we had no way of confirming if PT was completed, nor could we quantify how much of its effect improved patient prognosis with regard to isolated TPFx or SPFx. [thejns.org]

Outlook / Prognosis What can I expect if I have a transverse fracture? If you have a transverse fracture, you should expect to make a full recovery. [my.clevelandclinic.org]

Etiology blunt trauma lateral flexion-extension injury psoas muscle avulsion Malgaigne pelvic fracture Associations Although a minor injury to the lumbar spine, transverse process fractures require major force: cervical transverse process fractures have [radiopaedia.org]

Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. [researchweb.org]

Etiology: In general, compared with adults, pediatric patients have greater ligamentous flexibility and elasticity, shallower and more horizontal facets, and relative paraspinal muscle immaturity. [posna.org]

Epidemiology /Etiology “In 2005, osteoporosis was responsible for more than 2 million fractures; approximately 547,000 of those were vertebral fractures. [physio-pedia.com]

Epidemiology of Vertebral Fractures. J Clin Densitom. Jan-Mar 2016;19(1):8-22. Kevin Phan, Prashanth J Rao, Ralph J Mobbs. [danielebarnabei.it]

Currently, there is a paucity of research in sport-related TPF with the existing literature taking the form of epidemiological studies or case reports. These are detailed as follows. [academic.oup.com]

Epidemiology: Fractures of the thoracolumbar spine account for 1% to 2% of all pediatric fractures. The most common cause of pediatric spine trauma is motor vehicle accidents (even when seat belts are used), which lead to 33% to 58% of all injuries. [posna.org]

Tall RL, DeVault W: Spinal injury in sport: epidemiologic considerations. Clin Sports Med. 1993, 12 (3): 441-8. [bmcsportsscimedrehabil.biomedcentral.com]

Epidemiology /Etiology “In 2005, osteoporosis was responsible for more than 2 million fractures; approximately 547,000 of those were vertebral fractures. [physio-pedia.com]

In one cohesive source, the book brings together information on state-of-the-art clinical imaging—including multidetector CT and high-field MRI techniques—and the pathophysiology, neurologic evaluation, medical management, surgical treatment, and postoperative [books.google.com]

(LoE: 1A) Peng B., Pathophysiology, diagnosis, and treatment of discogenic low back pain, World J Orthop 2013 April 18; 4(2): 42-52 (LoE: 5) Davis JM, Beall DP, Lastine C, Sweet C, Wolff J, Wu D. Chance fracture of the upper thoracic spine. [physio-pedia.com]

Compared to adults, children have a different fulcrum because of a relatively large head, the vertebrae are not completely ossified, and the ligaments are firmly attached to articular bone surfaces that are more horizontal, making the pathophysiology [emedicine.medscape.com]

Prevention Most fractures happen due to accidents. Healthy bones and muscles may prevent injury. This may be done through diet and exercise. [winchesterhospital.org]

A brace may be used to help protect the injured area and prevent any bending, twisting and lifting movements. [thespinehealthinstitute.com]

How can I prevent a transverse fracture? Transverse fractures are usually caused by falls or other accidents that are hard to prevent. If you need them, use a cane or walker to increase your stability and prevent falls. [my.clevelandclinic.org]

We discuss uniqueness in the mechanism of such injuries and expatiate on the preventive and treatment aspects of management. [bmcsportsscimedrehabil.biomedcentral.com]

This will begin with medication to manage pain and prevent infection. Rest will be important in the days following the procedure, but it will also be important to move around as much as you can. [sonuahluwaliamd.com]

1. Green NE, Swiontkowski MF. Skeletal Trauma in Children: Expert Consult - Print and Online, 4e. Saunders; 2003.
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 (3):831-834.
3. Miller CD, Blyth P, Civil ID. Lumbar transverse process fractures: A sentinel marker of abdominal organ injuries. Injury. 2000;31:773–776.
4. Krueger MA, Green DA, Hoyt D, Garfin SR. Overlooked spine injuries associated with lumbar transverse process fractures. Clin Orthop Relat Res. 1996;327:191–195.
5. Brynin R, Gardiner L. Missed lumbar transverse process fractures in a high school football player. J Manipulative Physiol Ther. 2001;24:123–126.
6. Epstein BS. The spine: A radiological text and atlas. 4th ed. Philadelphia: Lea and Febiger; 1976. p. 572.
7. Daglar B, Bayrakçi K, Tasbas BA, et al. Importance of lumbar vertebra transverse process fractures in multitrauma patients who had undergone emergent laparotomy. Ulus Travma Acil Cerrahi Derg. 2005;11:58–63.
8. Gestring ML, Gracias VH, Feliciano MA, et al. Evaluation of the lower spine after blunt trauma using abdominal computed tomographic scanning supplemented with lateral scanograms. J Trauma. 2002;53:9–14.
9. Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008;65:832–836.