From the Guidelines
Treatment for Transverse Fracture of the Lumbar Spine
The treatment for a transverse fracture of the lumbar spine primarily aims to stabilize the fracture, alleviate pain, and prevent further injury. Initially, bed rest is recommended for a period of 2-4 weeks to reduce movement and stress on the fracture site 1.
Pain Management
Pain management is crucial and can be achieved with medications such as:
- Acetaminophen (up to 1000mg every 6 hours)
- Ibuprofen (up to 800mg every 8 hours) for mild to moderate pain. For more severe pain, opioids like oxycodone (5-10mg every 4-6 hours) may be prescribed, but their use should be closely monitored and limited to the shortest duration necessary due to the risk of dependency 1.
Physical Therapy and Support
Physical therapy should be initiated as soon as the patient can tolerate it, focusing on gentle exercises to maintain range of motion and strength without putting excessive stress on the fracture site. A brace or orthotic device may be recommended to provide external stabilization and support during the healing process, which typically lasts several months.
Surgical Intervention
In cases where the fracture is unstable or there are neurological deficits, surgical intervention may be necessary. This can involve procedures such as:
- Spinal fusion
- The use of instrumentation (e.g., rods and screws) to stabilize the spine. The decision for surgery should be made on a case-by-case basis, considering the severity of the fracture, the patient's overall health, and the presence of any neurological symptoms 1.
Follow-Up
Follow-up with an orthopedic specialist or a spine surgeon is essential to monitor the healing progress and adjust the treatment plan as necessary. A multidisciplinary approach, including interventional radiology, surgery, and radiation oncology consultation, may be recommended for patients with specific complications such as pathologic fracture with severe and worsening pain or spinal deformity 1.
From the Research
Treatment for Transverse Fracture of the Lumbar Spine
The treatment for a transverse fracture of the lumbar spine can vary depending on the severity of the fracture and the presence of other spinal injuries.
- Surgical treatment may be necessary for some cases, such as those with spinal instability or neurological deficits 2.
- Conservative management, including pain medication and bracing, may be sufficient for other cases, such as isolated transverse process fractures without spinal instability or neurological deficits 3, 4.
- In some cases, a fracture site in situ block, which involves injecting local anesthetics and steroids directly into the fracture site, may be used to help manage pain and accelerate recovery 5.
Factors Influencing Treatment
The treatment approach may be influenced by several factors, including:
- The presence of other spinal injuries, such as vertebral fractures or discoligamentous injuries 6, 4.
- The presence of non-spinal injuries, such as abdominal or pelvic injuries 3, 4.
- The level of the fracture, with thoracic and L1 transverse process fractures being more predictive of associated thoracic non-spinal injuries, and L5 transverse process fractures being more associated with pelvic fractures 4.
Clinical Management
Clinical management of transverse fractures of the lumbar spine should involve careful evaluation for associated spinal and non-spinal injuries, as well as monitoring for potential complications, such as spinal instability or neurological deficits 6, 4.
- Spine service consultation may not be necessary for isolated transverse process fractures without spinal instability or neurological deficits 3, 4.
- However, detection of a transverse process fracture should raise suspicion for a high likelihood of associated non-spinal injuries, and careful evaluation and management of these injuries is necessary 4.