Treatment for L2 and L3 Transverse Process Fractures on the Left
Isolated transverse process fractures of L2 and L3 should be managed conservatively with pain control, gradual mobilization, and do not require surgical intervention or spine specialist consultation. 1
Initial Assessment and Management
Pain Management
- First-line treatment: Non-opioid analgesics (acetaminophen, NSAIDs)
- For moderate to severe pain: Short-term opioid analgesics may be considered
- Consider muscle relaxants for associated muscle spasm
Activity Recommendations
- Initial rest for 1-2 weeks during acute pain phase
- Gradual mobilization as pain allows
- Avoid activities that increase pain
- Return to normal activities typically within 4-6 weeks
Follow-up Care
Physical Therapy
- Begin after acute pain subsides (typically 1-2 weeks)
- Focus on:
- Core strengthening
- Lumbar stabilization exercises
- Gradual return to previous activity level
Imaging
- Initial diagnosis typically made with CT scan
- Follow-up imaging generally not required unless symptoms worsen or fail to improve
- Standing X-rays may be considered if instability is suspected 2
Special Considerations
When to Consider Additional Intervention
- Persistent pain beyond 3-4 weeks
- Failure to respond to conservative management
- Worsening neurological symptoms
Advanced Interventions for Refractory Cases
- Consider fracture site in situ block (CT-guided injection of local anesthetic and steroid) for persistent pain 3
- This intervention may accelerate return to daily activities in cases not responding to conservative management
Important Caveats
Red Flags Requiring Further Evaluation
- Development of neurological symptoms
- Worsening pain despite appropriate management
- Evidence of instability on follow-up imaging
Associated Injuries
- Carefully assess for abdominal injuries, which frequently accompany transverse process fractures 1
- Evaluate for other spinal injuries, as isolated transverse process fractures are stable but may coexist with unstable injuries 2
Return to Activities
- Light activities: 2-3 weeks as tolerated
- Full activities: 4-6 weeks for most patients
- Contact sports: Minimum 4 weeks after injury 4
Prognosis
The prognosis for isolated transverse process fractures is excellent. Most patients experience complete resolution of symptoms within 6-8 weeks with appropriate conservative management 5. Unlike vertebral body fractures, transverse process fractures do not typically require spine specialist consultation or surgical intervention 1.
Most importantly, research has demonstrated that isolated transverse process fractures are structurally and neurologically stable injuries that do not require surgical intervention or bracing 1. However, careful assessment for associated injuries is essential, as these occur frequently and may require additional treatment.