0:01

I want to reference this manuscript written by one

0:04

of my favorite research fellows, Mona Shahriari.

0:08

She looked at the experience at Christiana Care

0:11

Hospital in looking for lumbar spine fractures.

0:15

And what she found was that of the 113 patients who had lumbar

0:20

spine fractures, 58 had isolated transverse process fractures,

0:25

and 42 had isolated compression fractures.

0:28

So, actually,

0:29

transverse process fractures of the lumbar spine were

0:32

more common than the compression fractures.

0:34

When she looked at the rate of visceral injuries,

0:39

what she noted that was that the odds ratio of a visceral injury

0:44

with transverse process fracture was 4.4, and was

0:48

higher than those with compression fracture.

0:50

So injury internally either to the mesenteric structures

0:55

or to the soft tissues of the abdomen or pelvis, or

1:00

more common with transverse process fractures

1:02

as opposed to compression fractures.

1:05

Here you can see on the coronal reconstructions the multiple

1:09

transverse process fractures in this particular case.

1:12

And it's also shown here on the axial scans at the L5,

1:16

L4, and contralateral L3 levels.

1:20

As opposed to the transverse process fractures,

1:23

the compression fractures are usually best seen on the

1:26

sagittal reconstructions as opposed to the axial scans.

1:31

Here we have a patient who has a pancaked

1:34

vertebral body in the lumbar spine.

1:37

And you can see that on the axial scan there

1:39

was comminution of this fracture.

1:42

What's interesting about this particular example of a fracture

1:45

is that you see vacuum cleft phenomenon within the

1:48

vertebral body. This is an unusual phenomenon.

1:51

In this case,

1:52

the vacuum cleft phenomenon was due to adjacent disc vacuum

1:56

phenomenon that extended into the vertebral body.

1:59

But there is a differential diagnosis of compression deformity

2:03

with associated vacuum cleft abnormality.

2:07

And this is what's known as Kummell's sign,

2:10

which is avascular necrosis of the vertebral body.

2:14

It may be seen in patients who have osteoporosis.

2:16

It may be seen in patients with vertebroplasty,

2:19

but you may also see it in patients with sickle cell

2:22

disease or with patients who have the bends and avascular

2:27

necrosis on the basis of oxygenation change that

2:31

occurs with the bubbles during the deep diving.

2:35

So this is something that again is worthwhile mentioning

2:39

to try to get at the etiology for the compression fracture.

Case 33 - Transverse Process Fractures and Visceral Injury

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