Case 33 - Lumbar Transverse Process Fracture
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I'd like to make one teaching point about
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transverse process fractures.
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Here we have a patient who we're scanning through
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the lumbar spine. This is the 12th rib.
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We come to the L1 level.
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We have a transverse process fracture on the left.
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The right side doesn't look bad.
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We come to the L2 level.
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We have a transverse process fracture at the L2 level.
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The right side looks pretty good.
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We come to the L3 level.
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We have a transverse process fracture on the left side.
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The right side, maybe
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there's a small avulsion of the transverse process.
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We come down to the next level, it looks good.
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And the next level we're okay.
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So the points to be made here are that lumbar spine
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transverse process fractures often occur multiply.
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You may see it bilaterally usually because us
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of this avulsion by the psoas musculature.
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But most importantly is that if you are
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reading in general and find these
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transverse process fractures,
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you have a relatively high rate of abdominal
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pelvic visceral injury as well.
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So while this is focused on the spine,
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you do want to expand the field of view and look
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at the soft tissues of the abdomen and pelvis.
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Because pelvic visceral organ injury has a high rate
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when you have lumbar spine
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transverse process fractures.
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It's not that the transverse process
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itself injures the viscera,
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but the fact that you had an injury that was so extreme
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as to avulse those transverse processes is
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associated with an internal organ injury.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
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