Dados do Trabalho

Título

ISOLATED TRANSVERSE PROCESS FRACTURE OF THE LUMBAR VERTEBRA IN A PROFESSIONAL SOCCER PLAYER: REPORT OF TWO CASES AND A LITERATURE REVIEW

Introdução e Objetivo

Chronic disorders of the lumbar region are the most common injuries of the vertebral column in athletes, and according to the modality, the prevalence of low back pain can reach 86% [1-3]. The association between sports practice and a greater risk of developing spinal injuries is well established in the literature, specifically present in impact sports and repetitive motions of flexion–extension, rotation, and with axial load [3-5]. Traumatic lesions on the trunk in soccer players are even rarer. In 320 games of the last five FIFA Cups, these accounted only 7.2% of all lesions [6]. In 2 years and 6030 cases of the English Premier League, 6% of the cases had the same pattern [7]. Isolated transverse process fracture (ITPF) of the lumbar vertebrae is extremely rare and due to traction of the musculature that is inserted in the region, which is usually very painful and incapacitating [8]. We herein present two cases of this type of injury in professional soccer players during a soccer match.

Casuística e Método

Case report

Resultados

Tow cases are shown and discussed

Discussão

Brazil is globally recognized as a country of soccer, and this sport is mostly practiced by young men [10]. It is a very safe modality regarding spinal involvement, the most common being stress fracture [11]. Based on two extensive studies, dorsal trauma corresponds to less than 8% of all soccer injuries [6,7]. The incidence of direct contact trauma has decreased by 37% in the last three FIFA World Cups, reflecting a greater effort by referees to curb more serious misconduct and recklessness [6] ITPF of the lumbar spine is extremely rare, and may be caused by direct trauma, acute lateral flexion–extension and, mainly, by muscular traction [8] In an well-designed cadaver study by Barker et al., the action of the psoas major, lumbar, and transversus abdominis muscles and traction of the middle layer of the lumbar fascia were pointed out as the main causes of ITPF [12]. The thoracolumbar fascia plays an important role in the entire lumbosacral spine, acting as a hydraulic amplifier because of its capacity to contain intra-abdominal pressure and turn it into vectors of useful forces in stabilizing the segment [13]. Both the fascia and muscles cited have a large part of their insertion precisely in the transverse process, which explains the avulsion fracture in violent contractions caused by indirect trauma [14]. The clinical presentation is characterized mainly by important local pain associated with paravertebral muscle hypertonia. Antalgic scoliosis may be present, and no neurological changes or signs of radiculopathy should be observed because the lesion does not approach the nerve structures [8] Diagnosis is primarily radiographic, and computed tomography is the most sensitive detection method [8], although we believe that performing simple radiographs, and whenever possible magnetic resonance imaging, is necessary, so that the lesions of the associated soft parts are discarded, although no visceral lesion was found in a series of 29 cases by Tewes et al. [15]. The AO classification for spinal fractures originally did not specifically include this type of lesion [16], but the review of this classification classified it as A0 because it is stable and consequently benign and with a low probability of causing permanent functional disability

Conclusão

Treatment is imminently conservative, and the time to return to activities varies from 6 to 8 weeks, with full recovery of performance based on the literature.[18,19]. Analgesia, lumbar vest, and intense physiotherapy are part of the therapeutic arsenal. Local infiltration is a possibility for pain control but in no way authorizes the immediate return to the sport [19].