Isolated Transverse Process Spinal Fractures Increase the Likelihood of Incurring Visceral and Pelvic Injuries: A Retrospective Review at a Level-1 Trauma Center.

BACKGROUND

Although isolated transverse process fractures (ITPF) do not confer any inherent risk of compromised spinal stability, there is increasing interest in their overall prognostic significance. As a proxy for localized or directional forces in high-energy traumatic mechanisms, ITPF may serve as an indicator for the presence of other coexisting traumatic injuries. Specific injuries may be predicted by the presence of ITPF at specific spinal levels, but few studies have examined this in depth and may not account for confounding variables.

METHODS

We retrospectively analyzed data from 306 patients presenting with acute traumatic ITPF. ITPF number and location by spinal segment were determined from initial computed tomography. Mechanism of trauma, Injury Severity Score, and extent of non-spinal-associated injuries were recorded. Correlation analysis compared ITPF location with injury severity, non-spinal-associated injury location, type, and patterns. Significant injury associations were further explored with logistic regression analysis controlling for age, mechanism of injury, and Injury Severity Score.

RESULTS

The adjusted odds of pulmonary visceral injury was 4.69 (95% confidence interval, 2.33-9.44) times higher among patients with thoracic-level ITPF compared with other ITPF levels. Lumbar ITPFs had increased odds of abdominal visceral injury (odds ratio, 4.85; P = 0.0002), pelvic fractures (odds ratio, 4.2; P < 0.0001). The number needed to scan to observe a pelvic injury among patients with lumbar ITPF was 3. Other significant associations were also observed.

CONCLUSIONS

Spinal level of ITPF is associated with increased likelihood of specific patterns of injury, and additional investigation is warranted.