Transverse process fractures of the cervical vertebrae: are they insignificant?

Transverse process fractures of the cervical vertebrae have been considered rare and insignificant. In a retrospective study of 216 patients with cervical fractures evaluated by plain films and computed tomography, we found that transverse process fractures were common. Transverse process fractures were present in 24% of patients with cervical fractures and accounted for 13.2% of all cervical fractures. Cervical radiculopathy and brachial plexus palsy were present in 10% of patients with transverse process fractures. In 78% of transverse process fractures, CT scanning showed that the fracture extended into the transverse foramen. Vertebral angiography, performed in eight patients with fractures involving the transverse foramen, showed dissection or occlusion of the vertebral artery in seven (88%) instances. Two of these seven patients had clinical evidence of vertebral-basilar artery stroke. Vertebral angiography should be considered when patients with transverse process fractures extending into the transverse foramen develop signs and symptoms of vertebral-basilar artery insufficiency.