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Transverse Process Fracture of the Spine

Transverse Process Fracture of the SpineJeffrey R. Carlson, MD, CPE

Most of you are familiar enough with human anatomy to know that the spine has bones called vertebrae that are stacked upon one another, sandwiched between vertebral discs that help us walk upright, bear our weight, bend, and even let us perform gymnastics if necessary. However, many people don’t know that on the backside and side of those vertebrae, there are three bony protrusions, called processes. There is one in the middle, called the spinous process and one on each side, called the transverse process.

I’m going to focus on the wing men, the transverse processes, and discuss the middleman, the spinous process, in another article. So, what purpose do these weird, little finger-shaped bones serve anyway? Love to do the Cupid Shuffle or the Cha Cha Slide at weddings and parties? Thank your transverse processes. The transverse processes are attached to ligaments that stabilize the vertebral column and to muscles that help us bend and move our spinal bones. When one or more of those outside processes break, we call that a transverse process fracture (TPF). Here, I will detail the causes, symptoms, how this fracture is diagnosed and finally, how I would treat this type of fracture.

A transverse process fracture is typically the result of a high-impact collision, such as a contact sports injury or motor vehicle accident, but it can also be caused by trauma such as a gunshot wound or a fall from a high altitude. Often, individuals will anticipate the trauma (they see the head-on collision coming, know they are falling off a horse, etc.) and brace for impact.  By doing so, they increase their chances of having a TPF, because the spine twists out of alignment just before the traumatic force occurs.  Those muscles and ligaments attached to the processes may be constricted by the bracing and cause the bony end of the transverse process to snap off.

The symptoms of a TPF are:

  • severe pain, especially at the site of the fracture
  • difficulty moving, bending, or twisting
  • swelling and bruising

This type of injury is most often diagnosed at an ER with x-rays or a CT scan. Most often, patients are sent home to recover as these injuries do not cause mechanical instability to the spine.  They’ll be given a back brace to help keep them somewhat immobile, told to intermittently ice for 48 hours, to lie flat, not to sit much, rest and take their pain medication.  As with any fracture, the bone typically will heal within a 4–8-week period.  Occasionally, a patient will have chronic pain from this type of fracture, and I will need to go in to surgically repair the break. That would be done as an outpatient procedure and the patient would go home the same day to recover.

The patient should not lift more than 5-15 pounds during their recovery period as they continue to wear their immobilizing brace.  I will ascertain when it is appropriate for them to begin at home exercises and Physical Therapy, as well as when it will be appropriate for them to transition to outpatient PT.  It will be important for them to maintain strength and range of motion, while preventing muscle atrophy and wasting during recovery.

Sometimes, the force needed to cause this type of fracture can cause other internal injuries and bleeding that may not immediately be evident.  That is why it is important to monitor the patient for any of the following signs for a few days after their trauma:

  • numbness, weakness, or tingly-feeling muscles
  • loss of bladder and bowel control
  • bloody urine
  • chest pain or shortness of breath
  • back pain that spreads to either or both legs
  • numbness, pain or swelling in the legs

If any of these occur, the patient should seek emergency care immediately, as they indicate there may be internal trauma that has yet to be discovered.

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