Transverse Foramen Fractures

Transverse foramen fractures are the fractures which occur in or extend to transverse foramen. The transverse foramen is also known as foramen transversarium. Transverse foramen fractures are important because of their association of vertebral artery injury.

The transverse foramen is an opening on each of the transverse processes of the cervical spine which gives passage to the vertebral artery and vein and a sympathetic nerve plexus.

Cervical radiculopathy and brachial plexus palsy is found in 10% of patients with transverse foramen fractures.

Dissection or occlusion of the vertebral artery has been reported in 88%  of transverse process fractures that extend to transverse foramen.

Transverse foramen fractures in the cervical spine can cause injury to the vertebral artery. It can occur as a result of occlusion, laceration, or distractive avulsion of the artery.

The incidence of vertebral artery injury following lower cervical spine trauma has been reported to be as high as 46%.

Transverse foramen fractures have been associated with facet dislocations, facet fractures with translation, and transverse foramen fractures.

Majority of injuries are unilateral.

Diagnosis

Detection of the injury can has important influences on overall decision making.

An x-ray would raise the suspicion of transverse foramen fracture. MR arteriograms are an effective means of noninvasive diagnosis of vertebral artery occlusion or narrowing following cervical trauma.

Arteriography is another option. 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.

Bilateral vertebral artery injuries can be devastating, leading to cerebellar infarction.

Treatment of Transverse Foramen Fractures

The injury is managed on the lines of cervical injuries.

The vast majority of injuries are unilateral, which have a very low rate of clinical sequelae. In most cases, no specific treatment is necessary. Most of the injuries of vertebral artery are also asymptomatic.

Vertebral artery injuries associated with cervical spine trauma most frequently involve the second segment that runs through the transverse foramen of C6 to C1. If the collateral flow is inadequate, an occlusion may cause vertebrobasilar ischemia.

However, the presence of arterial injury does affect the treatment decision of the fracture.