Implications of Isolated Transverse Process Fractures: Is Spine Service Consultation Necessary?

• Published in: World neurosurgery 2016-11, Vol.95, p.285-291
• Main Authors: Boulter, Jason H., BS, Lovasik, Brendan P., MD, Baum, Griffin R., MD, Frerich, Jason M., MD, Allen, Jason W., MD, Grossberg, Jonathan A., MD, Pradilla, Gustavo, MD, Ahmad, Faiz U., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Emergency Service, Hospital - standards; Emergency Service, Hospital - trends; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neurosurgery; Outcomes; Patient Discharge - standards; Patient Discharge - trends; Quality improvement; Referral and Consultation - standards; Referral and Consultation - trends; Retrospective Studies; Spinal fracture; Spinal Fractures - diagnosis; Spinal Fractures - therapy; Spine trauma; Transverse process
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.08.027

Abstract Background Acute traumatic isolated transverse process fractures (ITPFs) are increasingly identified in trauma patients due to increased use of routine computed tomography imaging. Despite repeated demonstrations that these fractures are only treated symptomatically, consultation patterns to the spine service have not changed. We aim to provide information on long term outcomes following conservative treatment to help clarify the role of the spine service in the treatment of ITPFs. Methods A retrospective chart review of 306 patients presenting with ITPFs was conducted to identify both short and long term outcomes for patients. A subsection of patients was identified with no other traumatic injuries as isolated ITPFs (iITPFs). Results No patient required surgical intervention for an ITPF and 97.7% of all patients and 100% of iITPF patients did not require bracing. At last follow up, all patients were neurologically intact, 97.8% were fully ambulatory, and 87.9% had no ITPF related back pain. When only patients with 6 or more months of follow up were considered, all patients were fully ambulatory and only 1.1% of all patients and none of the iITPF patients had persistent back pain. Conclusion ITPFs can be treated conservatively without concern for long term outcome sequelae such as pain, neurologic deficits, or ambulatory difficulties. As a result, spine service consult is not required for ITPFs.