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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.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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