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.

• Left Flank Pain

  He drove himself here to the hospital and currently is standing at the side of the bed complaining of pain in the left lower back, left elbow, and left flank pain. The pain in the back has not radiated. [drhem.wordpress.com]

  After substitution, lower back and left flank pain persisted, associated with some difficulty in breathing. Initial examination revealed diffuse left lateral lumbar pain to palpation. [academic.oup.com]

• Oral Bleeding

  There was no history of vomiting, seizures or oral bleed. Abdominal examination was soft and non-tender. Bowel sound was normal and there was no hepato-splenomegaly. The patient was conscious, alert and oriented to time, place and person. [joas.in]

• Scleral Icterus

  No scleral icterus. ENT: His oropharynx is clear with moist mucous membranes. NECK: Trachea is midline, no tenderness in the cervical spine to palpation CARDIOVASCULAR: Heart has a regular rate and rhythm. There is no S3, S4. [drhem.wordpress.com]

• Back Pain

  Postural causes of low back pain Scoliosis - this is an S shape deformity in the spine. Hyperlordosis - is an exaggerated lumber curve in the spine. [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]

  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]

  Weksler N, Velan GJ, Semionov M, et al: The role of sacro-iliac joint disruption in the genesis of low back pain: the obvious is not always right. Arch Orthop Trauma Surg. 2007, 127 (10): 885-8. 10.1007/s00402-007-0420-x. 7. [bmcsportsscimedrehabil.biomedcentral.com]

• Low Back Pain

  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]

  Postural causes of low back pain Scoliosis - this is an S shape deformity in the spine. Hyperlordosis - is an exaggerated lumber curve in the spine. [sportsinjuryclinic.net]

  Weksler N, Velan GJ, Semionov M, et al: The role of sacro-iliac joint disruption in the genesis of low back pain: the obvious is not always right. Arch Orthop Trauma Surg. 2007, 127 (10): 885-8. 10.1007/s00402-007-0420-x. 7. [bmcsportsscimedrehabil.biomedcentral.com]

  Risk factors for the development of low back pain or injury in athletes [ 6, 7 ] include: 1. Muscular imbalances or weaknesses of the abdominal and posterior spinal muscles. 2. Deficits in the afferent or efferent pathways or proprioceptors. 3. [link.springer.com]

  Key words: spinal fractures, low back pain, tomography, x-ray computed, aged, case reports. REFERENCIAS Yunhak L, Tong Jin C. [medigraphic.com]

• Spine Pain

  Decreased range of motion in the spine. Pain when bending or twisting. Tenderness. Swelling at the fracture site. [drdavidchangmd.com]

• Elbow Pain

  Left elbow pain. 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]

• Microscopic Hematuria

  This is to assess for microscopic hematuria or gross hematuria. There is controversy related to the evaluation of ureteral injuries, by means of urinalysis. Hematuria is found in 74% of cases (either gross or microscopic.) [drhem.wordpress.com]

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]

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]

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

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]

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]

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]

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

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

Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses and risk factors for spinal cord injury. Spine J. 2017 Jul 21. [Medline]. [emedicine.medscape.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]

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]

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

Hospital for Sick Children Health A-Z Search a complete list of child health articles expand_more View All Drug A-Z Search a list of articles about medications expand_more View All Learning Hubs Browse a complete list of content groups Healthy Living & Prevention [aboutkidshealth.ca]

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.