What is a Mildly Displaced Left C6 Transverse Process Fracture?
A mildly displaced left C6 transverse process fracture is a break in the bony lateral projection of the sixth cervical vertebra that extends from the vertebral body, with slight movement of the fractured fragment from its normal anatomical position.
Anatomical Context
The C6 transverse process consists of anterior and posterior tubercles connected by a costotransverse bar, through which the vertebral artery passes in the transverse foramen. When fractured with displacement, this injury carries significant risk for vertebral artery injury, particularly when the fracture line extends into the transverse foramen 1.
Clinical Significance
Despite being traditionally considered a "minor" injury, C6 transverse process fractures are not insignificant and require careful evaluation for associated injuries 1. The key concerns are:
Vascular Injury Risk
- In 78% of cervical transverse process fractures, the fracture extends into the transverse foramen 1
- When the transverse foramen is involved, vertebral artery dissection or occlusion occurs in 88% of cases 1
- C6 transverse process fractures are considered a high-risk factor for blunt cerebrovascular injury (BCVI) requiring screening with CTA 2, 3
Neurological Complications
- Cervical radiculopathy occurs in 10% of patients with transverse process fractures 1
- Brachial plexus palsy can occur in 10% of cases 1
Associated Injuries
- Cervical spine fractures involving the transverse foramen at any level are high-risk indicators for BCVI 3
- Abdominal injuries occur frequently with transverse process fractures 4
- Other spinal injuries should be actively sought 4
Imaging Evaluation
CT is the gold standard for diagnosing transverse process fractures 5, with sensitivity of 94-100% for cervical spine fractures 3. However, for C6 transverse process fractures specifically:
- Multidetector CTA of the head and neck with IV contrast should be performed to screen for BCVI 2, given the high association with vertebral artery injury when the transverse foramen is involved 1
- CTA has pooled sensitivity of 64% and specificity of 95% for BCVI 2
- MRI with T1-weighted fat saturation sequences may be superior for identifying intramural hematoma 2
Management Approach
Isolated transverse process fractures are structurally stable and do not require surgical stabilization or spine service consultation 4. However, C6 fractures warrant more vigilant assessment than lumbar transverse process fractures due to vascular proximity.
Conservative Treatment Protocol
- Multimodal pain control with NSAIDs and muscle relaxants 6
- Early mobilization once vascular injury is excluded 5
- Cervical collar support may be used for comfort but is not structurally necessary 6
- Most patients achieve significant pain reduction and functional improvement within 3-6 weeks 5, 6
Critical Monitoring
- If signs or symptoms of vertebral-basilar artery insufficiency develop (dizziness, ataxia, diplopia, dysarthria), vertebral angiography should be performed immediately 1
- Monitor for delayed neurological symptoms including radiculopathy 1
Common Pitfalls
- Assuming all transverse process fractures are benign - C6 location carries higher vascular risk than thoracolumbar transverse process fractures
- Failing to obtain CTA screening - Missing the 88% rate of vertebral artery injury when the transverse foramen is involved 1
- Not examining for fracture extension into the transverse foramen - This finding mandates vascular imaging 1
- Overlooking associated spinal injuries - Search diligently for other cervical fractures or ligamentous injuries 4
Prognosis
For isolated C6 transverse process fractures without vascular or neurological complications, prognosis is excellent with conservative management 5, 6, 4. Pain and disability scores show significant improvement by 3 months 6. However, the presence of vertebral artery injury substantially alters prognosis and may require anticoagulation or antiplatelet therapy 2.