Do Multiple Isolated Vertebral Thoracolumbar Transverse Process Fractures Increase the Risk of Ligamentous Injury and Surgical Intervention in the Setting of Trauma?

Abstract

Background: Isolated thoracolumbar vertebral transverse process fractures (TPF) are often considered a stable injury. However, the use of advanced imaging such as magnetic resonance imaging and spine specialist consultation are often ordered as part of the routine workup of these fractures. The routine ordering of advanced imaging, spine specialist consultation, and delayed mobilization causes unnecessary economic and clinical burdens to patients and the overall healthcare system. Purpose: To determine if a higher number of isolated TPFs (iTPFs) lead to an increase in ligamentous injury to the spine, and whether ligamentous injury—if present—requires surgical intervention. Methods: The retrospective review was performed from 2009 to 2015, using a surgical trauma database to identify patients with greater than 3 isolated TPF (iTPF) to determine if iTPF leads to an increase in ligamentous injury to the spine and if this increase leads to increased surgical intervention. Results: A total of 102 patients were identified with complete follow up at 6 - 8 weeks post injury. The majority of the included patients suffered from blunt trauma. There was a small rate of ligamentous injury (n = 7, 7%) that did not require additional treatment. None of the fractures included were considered unstable. None of the patients included required surgical intervention during their hospital visit or in follow up visits. Conclusion: iTPFs are a stable injury to the thoracolumbar spine. There is a small rate of associated ligamentous injury that does not change the management or require further interventions. Thoracolumbar iTPFs do not automatically need spine specialist consultation and advanced imaging techniques.