Isolated Transverse Process Spinal Fractures Increase the Likelihood of Incurring Visceral and Pelvic Injuries: A Retrospective Review at a Level-1 Trauma Center Open Access

Abstract

Background: Although isolated transverse process fractures (ITPF) do not confer any inherent risk of compromised spinal stability, there is growing interest in their overall prognostic significance. As a proxy for localized or directional forces in high energy traumatic mechanisms, ITPF may serve as an indicator for the presence of other coexisting traumatic injuries. Specific injuries may be predicted by the presence of ITPF at specific spinal levels, but few studies have examined this in depth and may not account for confounding variables.

Methods: We retrospectively analyzed data from 306 patients presenting with acute traumatic ITPF. ITPF number and location by spinal segment were determined from initial CT. Mechanism of trauma, Injury Severity Score (ISS), and extent of non-spinal-associated injuries (NSAIs) were recorded. Correlation analysis compared ITPF location to injury severity, NSAI location, type, and patterns. Significant injury associations were further explored with logistic regression analysis controlling for age, mechanism of injury, and ISS.

Results: The adjusted odds of pulmonary visceral injury was 4.69 (95% CI: 2.33 , 9.44) times higher among patients with thoracic level ITPF compared to other ITPF levels. Lumbar ITPFs had increased odds of abdominal visceral injury (OR = 4.85, p=0.0002), pelvic fractures (OR = 4.2, p<0.0001). The “number needed to scan” to observe a pelvic injury among patients with lumbar ITPF was 3 patients. Other significant associations were also observed.

Conclusion: Spinal level of ITPF is associated with increased likelihood of specific patterns of injury, and additional investigation is warranted.

Table of Contents

Chapter I: Background & Review of Literature.................................................................. 1

Chapter II: Manuscript.......................................................................................................... 8

Titles & Author Affiliations......................................................................................................... 9

Abstract...................................................................................................................................... 10

Introduction................................................................................................................................ 11

Material & Methods................................................................................................................... 11

Outcome Classification........................................................................................... 12

Statistical Analysis................................................................................................. 12

Results........................................................................................................................................ 13

Discussion.................................................................................................................................. 16

Strengths & Limitations........................................................................................ 19

References.................................................................................................................................. 21

Tables & Figures........................................................................................................................ 25

Chapter III: Summary, Implications & Future Directions................................................ 31

Appendices.............................................................................................................................. 33

Table A.1: Crude Correlation Between Spinal Level & ISS...................................................... 35

Table A.2a: Crude Correlation Between Spinal Level    ITPF-Associated Visceral Injuries.......................................................................................... 36

Table A.2b: Crude Correlation Between Spinal Level   and ITPF-Associated Orthopedic Injuries............................................................................... 37

Table A.3: Prediction of Rib Fracture & Number   of Rib Fractures from Regression Models............................................................................... 38

 

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Keyword	Spine Trauma Patterns of Injury Transverse Process Spine Spinal Fracture Trauma Injury Severity Associated Injury Neurosurgery English
Committee Chair / Thesis Advisor	Goodman, Michael, Emory University
Committee Members	Ahmad, Faiz, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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