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| LETTER TO EDITOR |
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| Year : 2014 | Volume
: 2
| Issue : 2 | Page : 63-64 |
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Pitfalls in the radiographic diagnosis of the transverse processes fracture of the lumbar vertebrae
Kishor V Hegde1, Reddy V Umamaheswara1, Amit Agrawal2
1 Department of Radiology, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
2 Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| Date of Web Publication | 27-Nov-2014 |
Correspondence Address:
Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2319-2585.145607
How to cite this article:
Hegde KV, Umamaheswara RV, Agrawal A. Pitfalls in the radiographic diagnosis of the transverse processes fracture of the lumbar vertebrae
. J Orthop Allied Sci 2014;2:63-4 |
How to cite this URL:
Hegde KV, Umamaheswara RV, Agrawal A. Pitfalls in the radiographic diagnosis of the transverse processes fracture of the lumbar vertebrae
. J Orthop Allied Sci [serial online] 2014 [cited 2023 Oct 3];2:63-4. Available from: https://www.joas.in/text.asp?2014/2/2/63/145607 |
Dear Sir,
Transverse process fractures of the lumbar spine are considered benign fractures which can be caused by the direct trauma or psoas muscle avulsion. [1],[2],[3],[4],[5] A 40-year gentleman sustained injuries in a road traffic accident while overturning of the vehicle. There was history of loss of consciousness for 30 minutes. There was no history of vomiting, seizures or oral bleed. Abdominal examination was soft and non-tender. Bowel sound was normal and there was no hepato-splenomegaly. The patient was conscious, alert and oriented to time, place and person. At the time of examination, the patient was conscious, alert and oriented (GCS-E4V5M6). Pupils were bilateral equal and reacting. Cranial nerves were normal. Motor and sensory examination was normal. Vital signs and general examination was unremarkable. Computed tomography (CT) scan brain was normal. X-ray abdomen and pelvis was interpreted as normal [Figure 1]. The patient was managed conservatively and was apparently well. However, he was complaining of low back pain, non-radiating and minimal relief with analgesics. An MRI of the dorso-lumbar spine was performed and it was normal. Finally the patient underwent a CT scan of the dorso-lumbar spine and it showed the fractures of the L2 and L3 transverse processes [Figure 2]. The patient was advised best rest and brace for 6 weeks. At follow-up he is doing well. | Figure 1: Plain radiograph of abdomen and pelvis AP view showing psoas shadows and bowel gas apparently masking the fracture fragments (arrows)
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 | Figure 2: Helical CT scan with 3D reconstruction describing the finer details of the fractured fragments
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Transverse processes fractures of the lumbar vertebrae can result from direct trauma, violent lateral flexion-extension forces, avulsion of the psoas muscle and Malgaigne fractures of the pelvis. [6],[7],[8],[9] Usually these injuries were considered as stable and minor injuries that little need for intervention, however, many studies have recognized that these injuries are caused by high energy trauma and heavy impact and can be associated with significant associated visceral and skeletal injuries. [6],[7],[9],[10],[11],[12] These patients can have persistent low back pain following trauma and to make a diagnosis of the transverse process fracture a high index of suspicion is needed. [13] Although these are the minor injuries however in literature there is a statistically significant association between transverse process fractures, intra-abdominal injuries and associated skeletal injuries. [6],[9],[11],[14] Plain radiographs is initial investigation provide and make the diagnosis of transverse processes fracture quite simple and straight-forward. [13] However conventional radiography can be relatively insensitive in the diagnosis of transverse process fractures of the lumbar spine particularly in patient with multiple injuries, and where there are subtle fractures of the transverse processes. [11] In cases where there is high index of suspicion and plain radiographs looks apparently normal, it may be supplemented by technicium 99 m bone scintigraphy and CT. [6],[8],[13],[15] As we observed in present case the presence of bowel gas shadow made the initial detection of the fracture difficult, [6],[11] and the literature recommends the helical CT scan provided the greater details of the fractures. [6],[11],[15] The magnetic resonance imaging (MRI) scan is very sensitive to detect stress fractures at an early stage. [13] The fracture of the lumbar transverse spine fracture usually takes about 6 weeks and complete reset is recommended to achieve the union. [16] The cases of nonunion also settle and become asymptomatic over a period of time and with time. [13]
| References | |  |
| 1. | Agrawal A, Srivastava S, Kakani A. Isolated transverse process fracture of the lumbar vertebrae. J Emerg Trauma Shock 2009;2:217-8.  [ PUBMED]  |
| 2. | Khnokh LI. On fractures of transverse processes of the lumbar vertebrae in pelvic fractures. Ortop Travmatol Protez 1961;22:45-6. [ PUBMED] |
| 3. | Kennedy RH. Fractures of the transverse processes of the lumbar vertebrae. Ann Surg 1927;85:519-28. [ PUBMED] |
| 4. | Imamaliev AS, Valentsev GV, Zoria VI. Fractures of the transverse processes of the lumbar vertebrae (clinical picture and diagnosis). Ortop Travmatol Protez 1984:15-8. |
| 5. | Ucik O. Isolated fractures of transverse processes of lumbar vertebrae. Acta Chir Orthop Traumatol Cech 1950;17:285-8. [ PUBMED] |
| 6. | Krueger MA, Green DA, Hoyt D, Garfin SR. Overlooked spine injuries associated with lumbar transverse process fractures. Clin Orthop Relat Res 1996:191-5. |
| 7. | Miller C, Blyth P, Civil ID. Lumbar transverse process fractures-a sentinel marker of abdominal organ injuries. Injury 2000;31:773-6. |
| 8. | Brynin R, Gardiner L. Missed lumbar transverse process fractures in a high school football player. J Manipulative Physiol Ther 2001;24:123-6. |
| 9. | Sturm JT, Perry JF Jr. Injuries associated with fractures of the transverse processes of the thoracic and lumbar vertebrae. J Trauma 1984;24:597-9. [ PUBMED] |
| 10. | Gilsanz V, Miranda J, Cleveland R, Willi U. Scoliosis secondary to fractures of the transverse processes of lumbar vertebrae. Radiology 1980;134:627-9. [ PUBMED] |
| 11. | Patten RM, Gunberg SR, Brandenburger DK. Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma1. Radiology 2000;215:831-4. |
| 12. | Daðlar B, Bayrakçi K, Taþbaþ BA, Daðlar G, Ozdemir G, Delialioðlu OM, et al . Importance of lumbar vertebra transverse process fractures in multitrauma patients who had undergone emergent laparotomy. Ulus Travma Acil Cerrahi Derg 2005;11:58-63. |
| 13. | Bali K, Kumar V, Krishnan V, Meena D, Rawall S. Multiple lumbar transverse process stress fractures as a cause of chronic low back ache in a young fast bowler: A case report. Sports Med Arthroscopy Rehabil Ther Technol 2011;3:8. |
| 14. | Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8:817-31. |
| 15. | Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: Spine service management not needed. J Trauma 2008;65:832-6. |
| 16. | Sampsell E. Rehabilitation of the spine following sports injury. Clin Sports Med 2010;29:127-56. [ PUBMED] |
[Figure 1], [Figure 2]
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