The lumbar transverse processes project laterally from the junction of the pedicle and the superior articular process, providing attachment for the intertransverse ligaments, the middle layer of the thoracolumbar fascia, and the origins of the quadratus lumborum and psoas major. The L3 transverse process is typically the longest and most palpable.
L5 transverse process fractures are the most common lumbar transverse process fracture, occurring from direct trauma or avulsion by the iliolumbar ligament. Multiple lumbar transverse process fractures in trauma imply significant force and should prompt investigation for associated injuries. The transverse processes are the target for intertransverse fusion and lateral mass screw placement in lumbar instrumentation. Anomalous L5 transverse process-to-sacral fusion (sacralization) or L4-L5 pseudoarticulation are common variants visible on lumbar X-ray.
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