TITLE:
Do Multiple Isolated Vertebral Thoracolumbar Transverse Process Fractures Increase the Risk of Ligamentous Injury and Surgical Intervention in the Setting of Trauma?
AUTHORS:
Nickalus Khan, Jonathan Reding, Matthew Gilbert, Michael S. Muhlbauer, L. Madison Michael
KEYWORDS:
Transverse Process Fracture, Ligamentous Injury, Imaging, Spine Service Consultation
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.8 No.1,
January
18,
2018
ABSTRACT: Background: Isolated thoracolumbar vertebral transverse process fractures (TPF) are
often considered a stable injury. However, the use of advanced imaging such as
magnetic resonance imaging and spine specialist consultation are often ordered
as part of the routine workup of these fractures. The routine ordering of
advanced imaging, spine specialist consultation, and delayed mobilization causes
unnecessary economic and clinical burdens to patients and the overall
healthcare system. Purpose: To determine if a higher number of isolated
TPFs (iTPFs) lead to an increase in ligamentous injury to the spine, and
whether ligamentous injury—if present—requires surgical intervention. Methods:
The retrospective review was performed from 2009 to 2015, using a surgical
trauma database to identify patients with greater than 3 isolated TPF (iTPF) to
determine if iTPF leads to an increase in ligamentous injury to the spine and
if this increase leads to increased surgical intervention. Results: A
total of 102 patients were identified with complete follow up at 6 - 8 weeks
post injury. The majority of the included patients suffered from blunt trauma.
There was a small rate of ligamentous injury (n = 7, 7%) that did not require
additional treatment. None of the fractures included were considered unstable.
None of the patients included required surgical intervention during their
hospital visit or in follow up visits. Conclusion: iTPFs are a stable
injury to the thoracolumbar spine. There is a small rate of associated
ligamentous injury that does not change the management or require further
interventions. Thoracolumbar iTPFs do not automatically need spine specialist consultation
and advanced imaging techniques.