Case 29 - Transverse process fracture
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I'd like to talk briefly about one of the more
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subtle fractures of the cervical spine,
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and that is a fracture of the transverse process.
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I know in my career I've missed a couple of these.
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Fortunately,
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they haven't resulted in any difficulty with the patients
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because usually they're not unstable fractures.
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However,
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transverse process fractures are important in the cervical spine
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because they mark part of the border of the foramen
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transversarium where the vertebral artery is running.
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And therefore,
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whenever I am at the endpoint of looking
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at a cervical spine for fractures,
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I will usually go to the thin section images and just spend a
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lot of time looking at the transverse process and the foramen
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transversarium in order to identify the possibility of
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a fracture in that location.
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This is much, much easier.
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And we'll see this in the lumbar spine where transverse process
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fractures from avulsion from the psoas muscle
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are very, very common.
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Here you see a comminuted subtle fracture of the left transverse
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process that is extending to involve, obviously, the foramen
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transversarium where the vertebral artery resides.
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This is something that is seen on the 0.5 millimeter
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thick sections, but not on the thicker sections.
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You notice over here that we have a little piece
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of bone kind of flying in the breeze.
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This is a portion of the avulsed part of the transverse process
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that you see on the right side where it's also been fractured.
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So again, not an unstable fracture,
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but a fracture that may be associated with a vascular
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injury and vertebral artery dissection.
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Important not to miss. So scroll through it, you can do it
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relatively rapidly. Scroll through and make sure that all those foramen
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transversarium are intact, right and left before you close
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the study and say no evidence of fracture.
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Aha!
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Here we see an additional transverse process fracture
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at the C7 level with an avulsed portion,
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not continuous with the transverse process more
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approximately at the C7 level
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and another level of discontinuity.
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So, important to look at these easy fracture
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to miss in the cervical spine.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
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