LAUSR

OBJECTIVE Here we study the risk of associated spinal and non-spinal injuries (NSI) in the setting of observed thoracolumbar transverse process fracture (TPF). Additionally, we examine the clinical management of TPF. METHODS Patients treated at a Level I Trauma Center over a five-year period were screened for thoracolumbar TPF. Prevalence of associated spinal fractures and NSI, as well as relationship to level of TPF, was explored. Clinical management and follow-up outcomes were reviewed. RESULTS A total of 252 patients with thoracolumbar TPF were identified. NSI were commonly observed (70.6%, n=178), however associated spinal fractures were more rarely seen (24.6%, n=62, P<0.0001). No patients had neurologic deficits attributable to TPF and only three patients with isolated TPF were treated with orthosis. Among patients with outpatient follow-up (178, 70.6%), none developed delayed onset neurologic deficits or spinal instability. Thoracic TPF (odds ratio (OR) 3.56, 95% confidence interval (CI), 1.20-10.56) and L1 TPF (OR 2.48, 95% CI, 1.41-4.36) were predictive of associated thoracic NSI. L5 TPF was associated with pelvic fractures (OR 6.30, 95% CI, 3.26-12.17). There was no difference in rate of NSI between isolated TPF (70.0%) and TPF with associated clinically relevant spinal fracture (72.6%, P=0.70) CONCLUSIONS: Non-spinal injuries are nearly three times more common in patients with thoracolumbar TPF than associated clinically relevant spinal fractures. Spine service consultation for TPF may be unnecessary unless associated with a clinically relevant spinal injury, which represents a minority of cases. Detection of TPF, however, should raise suspicion for high likelihood of associated NSI.