An Ultrasound Image-and-Intervention Paradigm for a Neglected Lumbar Transverse Process Fracture - A Case Report of Diagnosis and Hydrodissection Treatment

Sep 28, 2026

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Lumbar transverse process fractures are often overlooked, causing chronic pain that may not respond to standard care. This case report presents diagnostic use of musculoskeletal ultrasound (MSK-US) and an ultrasound-guided hydrodissection approach for a neglected L2 transverse process stress fracture. A 41-year-old man with 18 months of refractory groin and thoracolumbar pain underwent MSK-US to localize cortical irregularity and step-off deformity. Using 5% dextrose in water (D5W), hydrodissection was performed to address suspected neurovascular entrapment. The patient reported 80% immediate pain reduction, 95% sustained reduction after weekly sessions, and resolution of exam deficits, with follow-up imaging showing bony healing.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Abstract

Introduction

Low back pain and diagnostic challenges

Posterior element (transverse process) fractures

Biomechanical role and typical mechanisms

Received 10/14/2025 Review began 10/24/2025 Review ended 11/26/2025 Published 11/30/2025 © Copyright 2025 Yoon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98190 Open Access Case Report Published via The Hong Kong Institute Of Musculoskeletal Medicine An Ultrasound Image-and-Intervention Paradigm for a Neglected Lumbar Transverse Process Fracture: A Case Report of Diagnosis and Hydrodissection Treatment Yonghyun Yoon 1, 2, King Hei Stanley Lam 3, 4, 5 , Jaeyoung Lee 2, Jaeik Choi 6, Gyung Seog KO 7 , Teinny Suryadi 8, 9, Anwar Suhaimi 10, 11 , Daniel Chiung-Jui Su 12 1. Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, KOR 2. Orthopedics, Incheon Terminal Orthopedic Surgery Clinic, Incheon, KOR 3. Faculty of Medicine, The University of Hong Kong, Hong Kong, HKG 4. The Board of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Kowloon, HKG 5. Faculty of Medicine, The Chinese University of Hong Kong, New Territories, HKG 6. Rehabilitation Medicine, Dr. Choi 's Rehabilitation and Medicine, Kyengido, KOR 7. Orthopedics, Ko GyungSeog Orthopaedic Clinic, Seoul, KOR 8. Physical Medicine and Rehabilitation, Synergy Clinic, Jakarta, IDN 9. Physical Medicine and Rehabilitation, Hermina Podomoro Hospital, Jakarta, IDN 10. Rehabilitation Medicine, University Malaya Medical Centre, Kuala Lumpur, MYS 11. Rehabilitation Medicine, University Malaya, Kuala Lumpur, MYS 12. Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, TWN Corresponding author: King Hei Stanley Lam, [drlamkh@gmail.com](drlamkh@gmail.com) Abstract Lumbar transverse process (TP) fractures are often overlooked, leading to chronic pain that is frequently refractory to standard treatments. This case report describes the diagnostic use of musculoskeletal ultrasound (MSK-US) and a novel therapeutic application of ultrasound-guided hydrodissection for a case of neglected TP stress fracture. A 41-year-old male presented with an 18-month history of chronic right groin and thoracolumbar pain, unresponsive to extensive prior treatments, including physical therapy, medications, and multiple nerve blocks. MSK-US confirmed a cortical irregularity and step-off deformity at the left L2 TP, with sonoguided digital palpation precisely localizing the source of his symptoms. An ultrasound-guided hydrodissection procedure was performed using 5% dextrose in water (D5W) to address suspected neurovascular entrapment. The patient reported an immediate 80% reduction in resting pain following the procedure. After two additional weekly sessions, he achieved a sustained 95% pain reduction and complete resolution of physical examination deficits. Follow-up imaging demonstrated evidence of bony healing. This case highlights MSK-US as a pivotal diagnostic tool for elusive chronic TP fractures and introduces ultrasound-guided hydrodissection as a novel, minimally invasive therapeutic strategy. This "image-andintervene " paradigm effectively provided rapid pain relief, functional restoration, and facilitated a healing environment, offering a promising approach for managing similar refractory chronic pain conditions. Categories: Physical Medicine & Rehabilitation, Pain Management, Orthopedics Keywords: chronic low back pain, dextrose prolotherapy, hydrodissection, intertransversarii muscles, lumbar transverse process fracture, musculoskeletal ultrasound, referred groin pain, regenerative injection therapy, sonoguided digital palpation, stress fracture Introduction Low back pain (LBP) represents one of the most prevalent and disabling musculoskeletal conditions worldwide, with a lifetime prevalence exceeding 80% and a significant socioeconomic burden due to healthcare costs

FAQs

Why are lumbar transverse process fractures frequently overlooked?

They are often marginalized in diagnostic and therapeutic schemas, which can delay identification despite causing persistent chronic pain.

How did musculoskeletal ultrasound contribute to diagnosis in this case?

MSK-US confirmed cortical irregularity and step-off deformity at the L2 transverse process, and sonoguided digital palpation precisely localized the pain source.

What was the treatment approach, and what were the outcomes?

Ultrasound-guided hydrodissection using 5% dextrose in water (D5W) targeted suspected neurovascular entrapment, producing immediate 80% resting pain reduction and sustained 95% reduction after additional weekly sessions, with exam deficits resolving and imaging suggesting bony healing.

Sep 28, 2026

Uploaded by moss~