From the Research
The treatment for an L5 transverse process fracture typically involves conservative management with pain control and gradual mobilization. Initial treatment includes rest for 1-2 weeks, followed by a progressive return to activities as tolerated. Pain management consists of NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks, and possibly short-term muscle relaxants such as cyclobenzaprine (5-10mg three times daily) for associated muscle spasms. Acetaminophen (650-1000mg every 6 hours) can be used as an alternative or supplement. Physical therapy should begin after the acute pain subsides, usually within 2-4 weeks, focusing on core strengthening and lumbar stabilization exercises. A soft lumbar brace may provide comfort during initial recovery but should be used short-term to prevent muscle weakening. Surgery is rarely needed for isolated transverse process fractures unless there are neurological deficits or associated injuries. These fractures typically heal well because they don't bear significant weight and don't affect spinal stability, with most patients returning to normal activities within 6-12 weeks depending on pain resolution and functional recovery. According to the most recent and highest quality study 1, isolated transverse process fractures are structurally and neurologically stable injuries, which do not require spine service intervention.
Some key points to consider in the treatment of L5 transverse process fractures include:
- The importance of diligent search for other spinal injuries or abdominal injuries when a transverse process fracture is identified 1
- The use of fracture site in situ block as a potential treatment option for patients with lumbar spine transverse process fractures who do not improve with conservative management 2
- The role of decompressive L5 transverse processectomy in the treatment of Bertolotti's syndrome, a condition characterized by abnormal enlargement of the transverse process of the most caudal lumbar vertebra 3
It is essential to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions for L5 transverse process fractures. A thorough evaluation of the patient's condition and careful consideration of the potential benefits and risks of different treatment options are crucial in determining the best course of treatment. As noted in the study by 4, conservative treatment options, including both passive therapy and exercise, can be beneficial in the management of L5 vertebral compression fractures, and a similar approach may be applied to the treatment of L5 transverse process fractures.