Isolated Transverse Process Fractures: A Systematic Analysis.

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Isolated Transverse Process Fractures: A Systematic Analysis.

World Neurosurg. 2017 Jan 17;:

Authors: Nagasawa DT, Bui TT, Lagman C, Lee SJ, Chung LK, Niu T, Tucker A, Gaonkar B, Yang I, Macyszyn L

Abstract
OBJECTIVE: To review the literature on isolated transverse process fractures (ITPFs) and provide evidence for and validate the current practice of conservative management.
METHODS: The PubMed database was searched for published literature related to ITPFs. Baseline patient (age, sex, presentation, mechanism of injury) and fracture (number of fractures, level, single or multi-segmental) characteristics were extracted. Management, and outcomes were also recorded. Statistical comparisons were ascertained through N-1 Pearson Chi-squared tests.
RESULTS: A total of 4 studies comprised of 398 patients with 819 ITPFs were evaluated. Mean age was 33.5 years (69% male and 31% female). No patients presented with neurological deficits. The most common mechanism of injury was motor vehicle accident (MVA), followed by falls. MVAs were more commonly the cause of ITPFs in pediatric versus adult patients (88% vs. 65%, p = 0.0001). Falls were more commonly the cause of ITPFs in adults than in children (18% vs. 9%, p = 0.05). Management strategies involved unrestricted movement, bracing and orthotics. Radiologic evidence of spinal instability or deformity was not reported in any of the cases. Mean follow-up was 20.5 months.
CONCLUSIONS: Our data suggests that non-surgical management of ITPFs leads to complete resolution of the fracture without evidence of permanent neurological deficit or spinal instability. However, interpretation of our results is limited by the paucity of meaningful literature reporting on long-term outcomes. Nevertheless, the results provide support for conservative management and highlights the need to markers or scenarios where the diagnosis of ITPF is actually likely to be erroneous.

PMID: 28108423 [PubMed - as supplied by publisher]

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