Transverse and Spinous Process Fractures

Background:

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. The spinous process serves to attach muscles and ligaments, which are therefore at risk for injury in the presence of an SP fracture. 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.

 

Guidelines for medical decision-making:

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:

 

·        4 or more contiguous TP fractures / SP fractures 

·        Bilateral TP fractures / SP fractures (regardless of the # of fractures)

·        All C-spine TP fractures / SP fractures

 

Additionally, Spine consultation is required for ANY fracture (including TP and SP) when a concern for ligamentous injury exists.

 

Key contributors:

Abby Josef, Trauma

Reviewed by: Jamie Wilson, Neurosurgery and Scott Vincent, Ortho Spine

 

Version Date:

January 2024

 

References:

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)