Understanding the Difficulty of Sustaining an L1 Transverse Process Fracture
Height: 5'11", Weight: 190 lbs, Age: 30 years. I've been experiencing issues related to spinal instability for the past three years, which began after I was bedridden with COVID for a week. Since that time, I've noticed a gradual increase in my weakness. Recently, an electromyography (EMG) test revealed potential issues with the nerve pathways leading from my lumbar spine to my legs. Consequently, my neurologist has recommended an MRI of my lumbar region, and I am currently awaiting those results. Upon reviewing my previous medical tests, I discovered that an x-ray taken earlier this year identified a pre-existing fracture of the L1 transverse process. Interestingly, I have never engaged in contact sports or been involved in any car accidents. The solitary incident that comes to mind is a fall off my longboard over ten years ago, where I landed on my back on concrete. I felt some soreness initially, but otherwise, I recovered within a couple of days. I'm curious about the level of force required to cause this type of fracture. My physiatrist noted it was a historical injury but didn't elaborate on it further. I am wondering if this fracture might be linked to my ongoing instability issues.
Answers (1)
9/2/2025, 9:30:50 PM
OpenHealth AI
You’ve raised important concerns regarding your L1 transverse process fracture and the potential link to your ongoing spinal instability. Let's break this down to address your inquiries and provide actionable next steps for you.
Summary of Key Points:
- A transverse process fracture can occur from minor trauma, such as falls, and might not always be the sole cause of instability.
- Your increasing weakness and potential nerve issues are concerns that will be clarified further with the upcoming MRI results.
- Understanding the nature of the fracture and its relation to spinal instability can guide your next steps in managing your health.
Explanation:
A transverse process fracture of the lumbar spine may result from various forces, including non-contact injuries like falls. Although often seen in athletes or during traumatic events, such fractures can occur from falls that may not seem severe at the time. Your fall ten years ago could have contributed, even if it did not lead to immediate severe symptoms. Chronic issues like instability can sometimes stem from such historical injuries, but often, they also involve mobility, strength, and other health factors, including potential nerve involvement.
The EMG results indicating issues with nerve pathways suggest that your symptoms might also relate to the activity of your spinal cord and nerves. It’s crucial to follow this up with your upcoming MRI, which should provide more detailed insight into the stability and condition of your lumbar spine.
Next Steps:
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Await MRI Results: This will give critical information about the current state of your spine, nerve compression, or any other abnormalities that could explain your symptoms.
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Monitor Symptoms: Keep track of any changes in pain, mobility, or weakness. Note any specific activities that worsen your condition.
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Engage in Rehabilitation: Depending on your MRI results and in consultation with your healthcare team, consider starting a physical therapy program focused on strengthening your core and back muscles, which can enhance spinal stability.
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Consider a Comprehensive Evaluation: If you haven't already, discuss with your neurologist or physiatrist the possibility of a more thorough evaluation of your spine's condition related to the fracture. Address any concerns or lingering symptoms you might have.
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Stay Informed: Research educational resources regarding transverse process fractures and spinal health to understand better how they can affect your overall stability and nerve function.
Support & Reassurance:
It's completely understandable to seek clarity about your health, especially with the symptoms and findings you've described. You're taking the right steps by seeking information and awaiting further evaluations. Remember, healing and managing conditions often take time and careful monitoring. Please feel free to ask further questions or share any updates; your health journey is important, and I'm here to help!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.