Apophyseal injury of the fifth lumbar transverse process in adolescent athletes: A report of two cases

Abstract

Lumbar transverse process injuries are rare in adolescent athletes, with very few documented cases related to sports activities, particularly involving the fifth lumbar region. This report aims to highlight the clinical presentation, diagnosis, and management of apophyseal injuries of the fifth lumbar transverse process in two adolescent athletes. Two adolescent athletes, a 14-year-old boy and a 15-year-old girl, presented with subacute onset of unilateral lower back pain (LBP) following repetitive athletic activities. Both patients had a history of spondylolysis that had previously healed. Initial clinical assessments, including physical examination and imaging studies (CT and MRI), were performed to diagnose the nature of their injuries. Conservative treatment, including rest and specific rehabilitation exercises, was employed. Both patients exhibited right-sided LBP exacerbated by specific movements, mimicking symptoms of lumbar spondylolysis. Imaging studies revealed no evidence of spondylolysis but indicated a slight widening of the growth plate and high-intensity signal changes in the right fifth lumbar transverse process apophysis. Both patients returned to their sports activities within a month of starting treatment, with no recurrence of symptoms reported during follow-ups. Apophyseal injuries of the fifth lumbar transverse process, though rare, should be considered in the differential diagnosis of adolescent athletes presenting with unilateral LBP, especially in the absence of acute trauma.

Keywords: Apophyseal injury; athlete; case report; lumbar spine; transverse process.

Graph 1.

Treatment timeline for Case 1: from onset to return to play. The patient's target competitive games were scheduled to take place 4 weeks after the diagnosis.

Graph 2.

Treatment timeline for Case 2: from onset to return to play.

Figure 1.

High-intensity signal changes were observed only on the right side of the L5 transverse process apophysis (arrows) in the axial view of the short-tau inversion recovery sequences on MRI (A). The axial view of the computed tomography-simulated sequences revealed a slight widening of the growth plate of the right L5 transverse process apophysis (arrows) (B).

Figure 2.

A slight widening of the growth plate of the right L5 transverse process apophysis (arrows) was observed on the axial view of the CT image (A). High-intensity signal changes on the right side of the L5 transverse process apophysis (arrows) and perimuscular high-signal spread (arrowheads) anterior to the transverse process were observed in the axial view of STIR sequences on MRI (B). At 3 months post-injury, MRI showed no high-intensity signal changes around the apophysis or surrounding perimuscular on the STIR sequence (arrows and arrowheads) (C).