Transverse process is a bony protrusion from the posterior aspect of the vertebra. Every cervical, thoracic and lumbar vertebra has a transverse process on either side. Although transverse process fractures (TPF) are considered minor spinal injuries, they occur as a result of major force and are often related to other serious injuries. Cervical transverse process fractures frequently appear in the context of other cervical spine fractures [1], vertebral artery dissection and blunt cerebrovascular injury (BCVI) while 35% patients with lumbar transverse process fractures have intraabdominal (hepatic, splenic, genitourinary and diaphragmatic) injuries [2]. Lumbar TPF are more common, involve the upper lumbar spine and are usually multiple [1]. They can occur as a result of blunt trauma e.g during motor vehicle accidents; violent lateral flexion-extension injuries e.g. during football or other sports; avulsion injury of the psoas muscle; or Malgaigne fractures of the pelvis.[3] [4] [5]. Although TPF have been reported to be associated with visceral injuries [2] [4], they can also occur in the absence of other vertebral and visceral injuries [6].

Patients usually present with sudden onset of severe pain following the injury with decreased range of motion in the region of the affected part of the spine. The pain may be aggravated with movement and there may be swelling and tenderness around the fracture site. If there are visceral injuries, patients may present with features of hypovolemic shock. Patients with isolated transverse process fractures do not present with neurological deficits.

Transverse process fractures are known to occur after high-velocity trauma and therefore all patients must be evaluated thoroughly for the presence of serious visceral injuries [3] [4] [7]. After eliciting the history of the type of injury, the physician should examine the cervical, thoracic and lumbar spine and abdominopelvic region followed by a detailed neurological evaluation. Laboratory tests are not helpful in diagnosis but can help to evaluate comorbid medical conditions. So complete blood count, blood sugar, serum chemistries, blood grouping, cross matching and urinalysis depending on the clinical presentation should be ordered. Urinalysis can help to identify renal injury while elevated amylase levels may be an indication of pancreatic injury and elevated cardiac markers can indicate cardiac contusion.

Conventional radiographs are not very helpful as they are frequently unable to detect TPF and concomitant visceral injuries in the emergency setting in the presence of bowel gas [1] [3] [8]. Computed tomography is, therefore, the investigation of choice as it can identify TPF successfully, as well as related visceral injuries [1] [4] [9]. Magnetic resonance imaging may be required if spinal cord trauma is suspected.

Treatment for a transverse process fracture is typically conservative, focusing on pain management and allowing the fracture to heal naturally. This may include rest, the use of a brace or support, and medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. Physical therapy may be recommended to strengthen the surrounding muscles and improve mobility. Surgery is rarely required unless there are complications or additional injuries.

The prognosis for a transverse process fracture is generally favorable, with most patients experiencing full recovery within a few weeks to months. The healing process can vary depending on the severity of the fracture and the patient's overall health. Complications are rare, but persistent pain or limited mobility may occur in some cases.

Transverse process fractures are most commonly caused by trauma, such as a fall, motor vehicle accident, or sports injury. The force of the impact can cause the transverse processes to break. Less commonly, these fractures may occur due to repetitive stress or as a result of underlying bone weakness from conditions like osteoporosis.

Transverse process fractures are relatively uncommon compared to other types of spinal fractures. They can occur at any age but are more frequently seen in young adults and middle-aged individuals due to their higher likelihood of experiencing traumatic events. Men are slightly more affected than women, likely due to differences in occupational and recreational activities.

The pathophysiology of a transverse process fracture involves the application of a force that exceeds the strength of the bone, leading to a break. The transverse processes are not weight-bearing structures, so the fracture does not typically affect spinal stability. However, the injury can disrupt the attachment of muscles and ligaments, contributing to pain and muscle spasms.

Preventing transverse process fractures involves minimizing the risk of trauma. This can be achieved through the use of protective gear during sports, practicing safe driving habits, and maintaining a healthy lifestyle to strengthen bones and muscles. For individuals with osteoporosis, appropriate medical management is essential to reduce fracture risk.

Transverse process fractures are a type of spinal injury resulting from trauma or stress. They are characterized by localized pain and are diagnosed through imaging studies. Treatment is usually conservative, focusing on pain management and rehabilitation. The prognosis is generally good, with most patients recovering fully. Preventive measures include reducing trauma risk and maintaining bone health.

If you have been diagnosed with a transverse process fracture, it's important to follow your healthcare provider's recommendations for rest and pain management. Most people recover well with conservative treatment, but it's crucial to avoid activities that could worsen the injury. Engaging in physical therapy can help restore strength and flexibility. Remember to take steps to prevent future injuries by staying active, using protective equipment, and maintaining a healthy lifestyle.

1. Green NE, Swiontkowski MF. Skeletal Trauma in Children: Expert Consult - Print and Online, 4e. Saunders; 2003.
2. Patten RM, Gunberg SR, Brandenburger DK. Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma. Radiology. 2000;215 (3):831-834.
3. Miller CD, Blyth P, Civil ID. Lumbar transverse process fractures: A sentinel marker of abdominal organ injuries. Injury. 2000;31:773–776.
4. Krueger MA, Green DA, Hoyt D, Garfin SR. Overlooked spine injuries associated with lumbar transverse process fractures. Clin Orthop Relat Res. 1996;327:191–195.
5. Brynin R, Gardiner L. Missed lumbar transverse process fractures in a high school football player. J Manipulative Physiol Ther. 2001;24:123–126.
6. Epstein BS. The spine: A radiological text and atlas. 4th ed. Philadelphia: Lea and Febiger; 1976. p. 572.
7. Daglar B, Bayrakçi K, Tasbas BA, 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.
8. Gestring ML, Gracias VH, Feliciano MA, et al. Evaluation of the lower spine after blunt trauma using abdominal computed tomographic scanning supplemented with lateral scanograms. J Trauma. 2002;53:9–14.
9. Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008;65:832–836.