Isolated transverse process fractures: spine service management not needed.
BACKGROUND
With the advent of holo-body computed tomography scanning of trauma patients, the radiologic diagnosis of transverse process fractures (TPF) has increased. The significance of this fracture has not been elucidated. Spine service (neurosurgical or orthopedic) consultation is frequently requested for patients with these fractures, stressing constraints on these practices. We hypothesize that isolated transverse process fractures (iTPF) are structurally and neurologically stable injuries, which do not require spine service intervention.


METHODS
Patients for this retrospective, institutional review board-approved study were identified by reviewing the daily neurosurgical census from July 2004 to February 2007. Data were collected by chart review on all patients with TPF-grouped into isolated fractures (iTPF) and fractures with other associated spinal injuries (aTPF). Other parameters evaluated included fracture location, other spinal injuries, nonspinal injuries, mechanical stability, neurologic findings, pain, and treatment (surgical stabilization or decompression or bracing or both).


RESULTS
Eighty-four patients with one or more TPF were identified-47 with iTPF and 37 with aTPF. All iTPF and aTPF patients were found to be neurologically intact. No patients with iTPF required surgery or bracing for spinal stability, but 4 aTPF needed surgery and 18 aTPF required bracing with a total of 22 requiring neurosurgical intervention (p < 0.0001). However, none of these patients received treatment for the TPF. Twenty-five patients had associated abdominal injuries (16 of 46 iTPF, 9 of 37 aTPF, p = 0.3335).


CONCLUSIONS
iTPF are not associated with neurologic deficit or structural instability requiring spine service intervention. Therefore, conservative management without neurosurgical or orthopedic consultation is appropriate. When TPF are identified, diligence in searching for other spinal injuries or abdominal injuries should be exercised, as these associated injuries occur frequently.
Bradley
Lucus H
LH
Division of Neurological Surgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri 65212, USA.
Paullus
Wayne C
WC
Howe
James
J
Litofsky
N Scott
NS
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000293:injuries; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization; D015601:Injury Severity Score; D007593:Joint Instability / Q000517:prevention & control; D008159:Lumbar Vertebrae / Q000293:injuries; D008297:Male; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D013131:Spine / Q000000981:diagnostic imaging* / Q000473:pathology; D013904:Thoracic Vertebrae / Q000293:injuries; D014057:Tomography, X-Ray Computed / Q000379:methods*; D019564:Unnecessary Procedures
D000700:Analgesics