The following lumbar spine x-ray is from a 60 year old patient who walked into the department with a chief complaint of lumbar back pain after a surfing accident. What can you see in the x-ray?

Here is a magnified view:

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The lumbar vertebral body height, pedicles and spinous processes all appear normal. This patient has a fracture of the right sided transverse processes of L1 and L2 which can be very well seen on the magnified view.

It is a stable fracture on its own. Why is this fracture important?

• It results from high impact trauma.
• The presence of this fracture should alert the treating doctor to the possibility of intra-abdominal injuries, especially renal injuries.

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