# Transverse and Spinous Process Fractures

**<span style="font-size: 12.0pt; color: #212121;">Background:</span>**

<span style="font-size: 12.0pt; color: #212121;">The majority of transverse process (TP) and spinous process (SP) fractures are structurally and neurologically stable injuries, which do not require spine service intervention. However there are some features which can be more worrisome for associated spinal cord and/or ligamentous involvement. Transverse process fractures are defined as those involving the transverse process only, **without** extension into the pedicle, lamina, or facet complex. <span class="ILfuVd" lang="en"><span class="hgKElc">The spinous process **serves to attach muscles and ligaments,** which are therefore at risk for injury in the presence of an SP fracture. </span></span>We sought to create inclusion criteria to ensure that consistent spine consultation is obtained for the most high risk of these generally low-risk, stable fractures.  
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**<span style="font-size: 12.0pt; color: #212121;">Guidelines for medical decision-making:</span>**

<span style="font-size: 12.0pt; color: #212121;">Trauma patients will receive imaging per usual protocol at the discretion of the treating team. TP and/or SP fractures may be identified on CT scan. If present, the following are indications for a spine consult:</span>

<span style="font-size: 12.0pt; font-family: Symbol; color: #212121;">·</span><span style="font-size: 12.0pt; font-family: 'Times New Roman',serif; color: #212121;"> <span class="apple-converted-space"> </span></span><span style="font-size: 12.0pt; color: #212121;">4 or more contiguous TP fractures / SP fractures<span class="apple-converted-space"> </span></span>

<span style="font-size: 12.0pt; font-family: Symbol; color: #212121;">·</span><span style="font-size: 12.0pt; font-family: 'Times New Roman',serif; color: #212121;"> <span class="apple-converted-space"> </span></span><span style="font-size: 12.0pt; color: #212121;">Bilateral TP fractures / SP fractures (regardless of the # of fractures)</span>

<span style="font-size: 12.0pt; font-family: Symbol; color: #212121;">·</span><span style="font-size: 12.0pt; font-family: 'Times New Roman',serif; color: #212121;"> <span class="apple-converted-space"> </span></span><span style="font-size: 12.0pt; color: #212121;">All C-spine TP fractures / SP fractures</span>

<span style="font-size: 12.0pt; color: #212121;"> </span>

<span style="font-size: 12.0pt; color: #212121;">Additionally, Spine consultation is required for ANY fracture (including TP and SP) when a concern for ligamentous injury exists.</span>

**<span style="font-size: 12.0pt; color: #212121;">Key contributors:</span>**

<span style="font-size: 12.0pt; color: #212121;">Abby Josef, Trauma</span>

<span style="font-size: 12.0pt; color: #212121;">Reviewed by: Jamie Wilson, Neurosurgery and Scott Vincent, Ortho Spine</span>

**<span style="font-size: 12.0pt; color: #212121;">Version Date:</span>**

<span style="font-size: 12.0pt; color: #212121;">January 2024</span>

**<span style="font-size: 12.0pt; color: #212121;">References:</span>**

A. Homnick et al. Isolated thoracolumbar transverse process fractures: call physical therapy, not spine. J Trauma. (2007)

L.H. Bradley et al. Isolated transverse process fractures: spine service management not needed. J Trauma (2008)

J. H. Boulter et al. Implications of isolated Transverse Process fractures: Is spine service consultation necessary? World Neurosurgery (2016)