Transverse process fracture

Transverse process fractures are common sequelae of trauma, although they are considered a minor and stable lumbar spine fracture. There is a strong association between transverse process fractures and other traumatic injuries.

Pathology

Transverse process fracture most commonly occurs in the upper lumbar spine and are commonly multiple . The fracture line can extend into the transverse foramen, and in the cervical spine there is a risk of complicating vertebral artery dissection.

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 a strong association with other cervical spine fractures andblunt cerebrovascular injury
• ~35% (range 20-50%) of patients with lumbar transverse process fractures have hepatic and splenic injuries, genitourinary and/or diaphragmatic injuries

Radiographic features

CT is the modality of choice. Up to 60% of lumbar transverse process fractures identified on CT will be missed on plain radiographs .

Differential diagnosis

In the lumbar region, consider anatomical variants such as:

• hypoplastic 12th rib
• unfused transverse process ossification center