Overlooked spine injuries associated with lumbar transverse process fractures

Transverse process fractures of the lumbar spine often are considered benign fractures related to direct trauma or psoas muscle avulsion. Treatment of these usually stable injuries is primarily administered when the patient becomes symptomatic. However, significant force often is required to cause these injuries, and other injuries may occur concomitantly. For this study, all patients who presented with identified lumbar transverse process fractures were further evaluated radiographically with computed tomography for the detection of other possible spine injuries. Medical and radiology records of 28 consecutive patients who had plain radiographs and computed tomography scans taken of their lumbar spine were reviewed retrospectively; these patients presented with lumbar spine transverse process fractures between January 1, 1989 and June 30, 1992. Three of the 28 patients (11%) had a lumbar spine fracture that was identified by computed tomography but overlooked on plain radiographs. Approximately 11% of patients with major injuries may be misdiagnosed if only plain radiographs are used in the evaluation of transverse process fractures. Computed tomography scanning of all lumbar spine transverse process fractures resulting from acute trauma should be considered because this diagnostic measure decreases the risk of overlooking potentially serious injuries.