Spinous Process and Transverse Process

Fractures

Fractures in the thoracic and lumbar spine that are nearly always stable and can
be managed without intervention, although associated abdominal injuries must
be sought. Rigid cervical immobilization may benefit patients with fractures in the
cervical spine.

Overview

• Spinous process avulsion fracture as a result of hyperflexion

• Transverse process fracture due to pull from attached ligaments or paraspinal
muscles

° Thoracic and lumbar

– 30 % associated with abdominal injuries

° Cervical
– 10 % with brachial plexus injury
– 88 % with vertebral artery injury
• L5 TP fracture in patient with pelvic fracture represents avulsion of the iliolum-
bar ligament, and may indicate vertical pelvic instability * IMPORTANT *

History

• Do you have other pains along your neck and back?

• Do you have headache, nausea or vomiting, or neurologic symptoms?

° r/o vertebral artery injury for cervical pathology

© Springer International Publishing Switzerland 2017 75

M.C. Makhni et al. (eds.), Orthopedic Emergencies,
DOI 10.1007/978-3-319-31524-9_21
76 M.C. Makhni et al.

Physical Exam

• Complete Trauma Exam (Appendix A)

• Complete Neurologic Exam (Appendix A)
• Abdominal exam

Imaging

• XRs: AP, lateral spine

• CT: as needed for further visualization (Figs. 1 and 2)
° Can assess if fracture extends beyond fracture into lamina
° Can rule out associated facet fracture or dislocation
• Vertebral Artery Angiograms
° Can perform for all cervical transverse process fractures

Treatment Plan

Nonoperative

• Observation and analgesia

° Nearly all isolated thoracic and lumbar spine process fractures

Fig. 1 Spinous process fracture

Spinous Process and Transverse Process Fractures 77

Fig. 2 Transverse process fracture

• Cervical collar

° Consider for cervical fractures

Operative (Rare)

• If extension into lamina with spinal cord compromise, consider decomp

ression ± fusion

Reference

Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service
management not needed. J Trauma. 2008;65(4):832–6.