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Transverse Spinous Process Fracture

You have fractured a transverse spinous process. There are two transverse processes that extend off each vertebra, one on each side. This is where the muscles and ligaments of the back attach to the spine. One of these muscles is the psoas muscle, which controls the forward bending motion of the upper body and thighs.

During a fall, car accident, or other forceful injury, the psoas muscle can contract strongly as the body tries to protect itself. The contraction can be strong enough to pull off a chip of bone from the spinous process, where the psoas muscle attaches.

This is a stable fracture and does not cause any injury to the spinal cord or nerves. However, the forces that cause this fracture can also cause internal bleeding and other internal injuries that might not be evident at the time of your first exam. So, watch for the signs below.

This injury will take 4 to 6 weeks to heal and can be treated at home with bed rest and pain medicine. Pain medicine and anti-inflammatory medicine (such as ibuprofen) can be used for a short term. A back brace (called TSLO) or abdominal binder may be prescribed to reduce pain by limiting motion at the fracture site.

Home Care:

  • You may need to stay in bed the first few days. But, as soon as possible, begin sitting or walking to avoid problems with prolonged bed rest (muscle weakness, worsening back stiffness and pain, blood clots in the legs).

  • When in bed, try to find a position of comfort. A firm mattress is best. Try lying flat on your back with pillows under your knees. You can also try lying on your side with your knees bent up towards your chest and a pillow between your knees

  • Avoid prolonged sitting. This puts more stress on the lower back than standing or walking.

  • During the first two days after injury, apply an ice pack to the painful area for 20 minutes every 2 to 4 hours. This will reduce swelling and pain. HEAT (hot shower, hot bath or heating pad) works well for muscle spasm. You can start with ice; then switch to heat after two days. Some patients feel best alternating ice and heat treatments. Use the one method that feels the best to you.

  • You may use an anti-inflammatory medicine such as ibuprofen (Motrin, Advil) along with your pain medicine, unless told otherwise. [Note: If you have chronic kidney disease or ever had a stomach ulcer or GI bleeding, talk with your doctor before using these medicines.]

  • If you were prescribed opioid pain medicine, take only as directed. (Do not drive or operate machinery while taking this medicine.) Call your doctor if your pain is not well controlled. A dose change or stronger medicine may be needed.

  • Be aware of safe lifting methods and do not lift anything over 15 pounds until all the pain is gone. Use a back brace if prescribed.

Follow Up

with your doctor in one week, or as advised by our staff, to be sure the bone is healing properly.

Get Prompt Medical Attention

if any of the following occur:

  • Increasing back or abdominal pain

  • Weakness, dizziness or fainting

  • Blood in your urine (pink, red or brownish color)

  • Weakness or numbness in one or both legs

  • Loss of control over bowels or bladder, or numbness in the groin (or genital area)

  • Chest pain or shortness of breath

  • Back pain spreads to one or both legs


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