Transverse Process Fractures of the Spine

First off lets start off the discussion with describing what the transverse process of the spine is and what is the mechanism that causes us to fracture it, in the first place. The transverse process are the lateral projections off the right and left of our cervical, thoracic, and lumbar vertebrae, and in general are considered a stable structure. If the transverse process is considered a stable structure why have we seen both Neymar the famous soccer player, and Tony Romo recently experience these injuries? The answer to that question lies in the mechanism of action that causes the injury. The most common mechanisms of injury for this type of injury is through blunt trauma (motor vehicle), avulsion of the psoas and by trauma that causes a sudden extreme lateral flexion/extension (getting hit in the back). All of these mechanism of actions require and extreme force and require further work up of any other possible fractures and organ involvement. One reason why there has been an increase in these types of fractures is the use of full body CT scans. CT scans more readily pick up these fractures when compared to x-ray. X-rays have the ability to pick up these fractures, but often times part of the intestines or other organs can be in the way, causing the fracture to go unidentified. Even though the transverse process fractures are somewhat rare they do account for 14% of all thoracic and lumbar fractures. The current therapy for these type of fractures when there is no other neurologic or other organ damage is conservative therapy. While over all these injuries are uncommon we will continue to see these type of injuries in sports where players are continually getting bigger, stronger, and are paid to make plays on the field

References:

Journal of Emergencies, trauma and shock, "Isolated transverse process fracture of the lumbar vertebrae" Amit Agrawal, Sandeep Srivastava, and Anand Kakani
up to date "Spinal column injuries in adults: Definitions, mechanisms, and radiographs" Amy Kaji, MD, PhD, Robert S Hockberger, MD, FACEP, MAria E Moreira, MD, Jonathan Grayzel, MD, FAAEM

Neymar Injury:
https://www.youtube.com/watch?v=G1o052POPJs

Tony Romo Injury:
https://www.youtube.com/watch?v=DFxxu8ztQGc