Case Report

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Journal of Acupuncture Research 2025; 42:46-52

Published online January 23, 2025

https://doi.org/10.13045/jar.24.0050

© Korean Acupuncture & Moxibustion Medicine Society

Integrative Korean Medicine for Pain and Functional Recovery in Lumbar Transverse Process Fractures: A Case Report and Literature Review

Ji-Sun Kim , Gyu-Bin Lee , Hong-Wook Choi , Do-Young Kim , Dong-Jin Kim , Dong-Ju Yoon , Ye-Rim Yun , Ji-Sung Yeum , Ik-Jun Cho

Department of Acupuncture and Moxibustion, Jaseng Hospital of Korean Medicine, Seoul, Korea

Correspondence to : Ji-Sun Kim
Department of Acupuncture and Moxibustion, Jaseng Hospital of Korean Medicine, 536 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea
E-mail: lovemintk@naver.com

Received: October 21, 2024; Revised: November 19, 2024; Accepted: December 5, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

The transverse processes function as essential attachment points for the muscles and ligaments surrounding the spine, and transverse process fractures (TPF) are commonly observed in trauma patients, such as those involved in traffic accidents. However, studies investigating the effectiveness of integrated Korean medicine (iKM) treatments for lumbar TPF have been limited. The present study aims to report a case of a traffic accident-induced lumbar TPF treated with iKM, which indicated significant improvement in pain and function. The patient was diagnosed with left TPFs at the L3 and L4 vertebral levels via radiological examination and underwent iKM treatments. After two weeks of iKM hospitalization, the numerical rating scale scores decreased from 5 to 3, the Oswestry Disability Index scores decreased from 53.33 to 35.56, and the EuroQoL-5 dimension scores increased from 0.675 to 0.771. In conclusion, our findings suggest that iKM treatments may be effective for patients with lumbar TPF in terms of pain and functional management.

Keywords Case reports; Integrated Korean medicine treatment; Lumbar transverse process fracture

Transverse processes are bony projections found on the lateral aspects of the spinal vertebrae. Transverse process fractures (TPF) commonly occur in patients with multiple traumas and may present as isolated injuries or alongside other vertebral fractures affecting the lamina, pedicle, facet joint, or vertebral body [1,2].

Within the framework of the thoracolumbar injury classification, TPF was initially categorized as a minor injury [3]. However, research from trauma centers has suggested that the impact of TPF on spinal dynamics may be more significant than previously thought, which is often more severe than the other types of spinal injuries, despite being frequently underestimated [4]. In many instances, patients are discharged from emergency care with prescriptions for pain management, typically including medications such as paracetamol [5].

Owing to the recent increase in the number of traffic accidents and industrial accidents, the cases of spinal fractures have increased, and the introduction of surgical treatment using metal fixation for vertebral fractures has led to several changes and developments. However, if the fracture is overlooked or unstable fractures are not properly treated, the patients will have poor treatment results [6].

Although many conservative treatments have been performed on TPF cases due to traffic accidents, research on the effectiveness of integrated Korean medicine (iKM) treatments for TPF has been limited. Therefore, we report a case of lumbar TPF caused by a traffic accident whose symptoms improved with iKM treatment.

1. Chief complaints and medical history

This study included a 41-year-old female who developed pain from both sides of the lower back to the pelvis after a car accident that occurred while she was riding on a bus on April 22, 2024. She presented with pain and bruising on the left side of her lower back. She had no relevant family history or history of medication use. She visited the hospital for the first time on April 26, 2024, without any treatment history, and was hospitalized from April 29 to May 12.

2. Radiography examination

The radiography scan (on April 26, 2024) of the lower back performed on the first day of visit indicated TPFs at the left L3 and L4 vertebral levels (Fig. 1). Magnetic resonance imaging (MRI) was performed three days later (on April 29, 2024) for additional diagnosis, but no special problems were observed except for TPFs at the left L3 and L4 vertebral levels (Fig. 2).

Fig. 1. X-ray image scan of the lumbar spine (April 26, 2024). After the L-spine series (anterior to posterior, lateral, oblique) was taken, transverse process fractures could be observed at the left L3 and L4 vertebral levels, especially in the anterior to posterior (A) and oblique view on one side (B). The yellow arrows indicate the lesion area. No abnormalities were observed in the oblique view on the other side (C) and lateral view (D).
Fig. 2. T1-weighted (A–C) and T2-weighted (D–F) magnetic resonance imaging (April 29, 2024). The sagittal section shows the left L3 and L4 TPF (A, D). The axial sections show the left L3 (B, E) and L4 TPF (C, F), respectively. The yellow arrows indicate the lesion area. TPF, transverse process fractures.

3. Treatment

1) Acupuncture therapy

Acupuncture was used for pain management (Table 1).

Table 1 . Summary table of interventions used in this study according to the Standard for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA)

ItemDetail
1. Acupuncture rationale1a) Style of acupunctureTraditional Korean acupuncture
1b) Reasoning for the treatment providedLiterature and clinical experience of experts
2. Details of needling2a) Number of needle insertions per subject per sessionFrom 5 to 10
2b) Name of points usedHuatuo Jiaji (EX-B2) points (low back), GV3 (Yaoyangguan) acupoint
2c) Depth of insertion30–35 mm
2d) Response soughtAcupuncture sensation “De qi”
2e) Needle stimulationManual stimulation
2f) Needle retention timeAt once
2g) Needle typeSterile 0.25 × 40 mm stainless needles (Dongbang Acupuncture Inc.)
3. Treatment regimen3a) Number of treatment sessions28
3b) Frequency and duration of the treatment sessionsTwice a day for 10–15 min (14 d)
4. Other components of the treatment4a) Details of other interventions administered to the acupuncture group (e.g., moxibustion, cupping, herbs, exercises, lifestyle advice)Herbal medicine, cupping therapy, and electronic moxibustion
4b) Setting and context of the treatment, including instructions to practitioners and information and explanations to patientsProcedure of the treatments
5. Practitioner background5a) Description of the participating acupuncturists (qualification of professional affiliation, years in acupuncture practice, other relevant experience)Korean medicine doctor of the acupuncture and moxibustion department with more than 6 months of experience
6. Control or comparator interventions6a) Rationale for the control or comparator in the context of the research question, with sources that justify this choiceNo control or comparator interventions
6b) Precise description of the control or comparator. If sham acupuncture or any other type of acupuncture-like control is used, provide details as for Items 1 to 3 aboveNo control or comparator interventions


2) Pharmacopuncture therapy

The patient was also treated with Shinbaro 2 pharmacopuncture (Jaseng Wonoe Tangjunwon) once a day (2 mL/day) using a 1-mL insulin syringe with a disposable needle (29 gauge × 13 mm). The needles were inserted into a depth of 1 cm, and the drug was administered at 0.5 mL per BL25 acupoint. To prevent infection, the treatment site was disinfected with a 10% povidone-iodine solution before and after the procedure (Table 2).

Table 2 . Contents of the Shinbaro-pharmacopuncture used in this study

Pharmacopuncture prescriptionHerbal medicine components (g/mL)AdministeredDaily dose
SJ3-SBO Shinbaro 2Paeonia lactiflora (0.0027)
Ostericum koreanum (Max) Kitagawa (0.0013)
Aralia continentalis (0.0013)
Cortex Eucommiae (0.0013)
Achyranthis Radix (0.0013)
Rhizoma Cibotii (0.0013)
Radix Ledebouriellae (0.0013)
Acanthopanacis Cortex (0.0013)
Scolopendra subspinipes mutilans (0.0013)
Day 1 to day 141 vial (2 mL/vial)


3) Herbal medicine

Dangguisusan-gamibang, which is used to treat patients with trauma injuries, was prescribed twice daily. Table 3 shows the herbal components, daily doses, and schedules.

Table 3 . Herbal medicine prescriptions

Herbal prescriptionHerbal medicine components (g/pouch)AdministeredDaily dose
Dangguisusan-gamibangAngelicae Gigantis Radix (4.000)
Paeoniae Radix Rubra (3.200)
Linderae Radix (3.200)
Cyperi Rhizoma (3.200)
Caesalpinia Lignum (3.200)
Carthami Flos (3.200)
Persicae Semen (2.800)
Cinnamon bark (2.400)
Glycyrrhizae Radix et Rhizoma (2.000)
Harpagophytum procumbens (2.000)
Drynaria fortune (2.000)
Roots of Asarum sieboldii (1.200)
Day 1 to day 14Two pouches


4) Other therapy

Transcutaneous infrared irradiation therapy was also applied for 10–15 minutes. Wet cupping therapy applied to the lumbar region and indirect moxibustion therapy were performed for 5–10 minutes twice a day, mainly in the governor vessel and EX-B2 acupoints. For this procedure, sterilized plastic cups (Dongbang Medical Co., Ltd.) and electronic moxibustion (Orange Medical Co., Ltd.) were utilized.

4. Assessments

The numerical rating scale (NRS), Oswestry Disability Index (ODI), and EuroQoL-5 dimension (EQ-5D) were used to evaluate the patient’s lower back pain, functional disability, and quality of life. The NRS pain assessment was conducted at 08:00 AM daily from the day of hospitalization. The ODI and EQ-5D were confirmed by evaluating the hospitalization and discharge dates. The patient’s range of motion (ROM) was evaluated to analyze the mobility of a particular joint. Specifically, we measured the lumbar spine’s movement for flexion, extension, lateral bending, and rotation.

5. Follow-up and outcomes

Upon admission, the patient had an NRS score of 5 for lower back pain, ODI score of 53.33, and EQ-5D score of 0.675. Lumbar spine ROM was noted as flexion of 10, extension of 5, and lateral bending of 20 bilaterally. Both the results of the straight leg raise test and Patrick tests were inconclusive due to pain. On the ninth day of hospitalization, the NRS score decreased to 4. On the discharge day (the 14th day of hospitalization), the NRS score further decreased to 3, ODI score decreased to 35.56, and EQ-5D score was 0.771 (Figs. 35). Moreover, the ROM had slightly improved to a flexion of 60, extension of 10, and lateral bending of 30 bilaterally (Table 4). During hospitalization, no adverse events were observed.

Fig. 3. Changes in the NRS scores for lower back pain according to the days of hospitalization. Asterisk indicates the time point when the NRS was initially measured and the time point when a change occurred. NRS, numerical rating scale.
Fig. 4. Changes in the ODI score by admission and discharge dates. ODI, Oswestry Disability Index.
Fig. 5. Changes in the EQ-5D by admission and discharge dates. EQ-5D, EuroQoL-5 dimension.

Table 4 . Summary table of changes in lumbar range of motion at admission and discharge

DateFlexion (°)Extension (°)The lat. bending (°)Rotation (°)
RtLtRtLt
2024.04.2910520204545
2024.05.12601030304545

lat., lateral; Rt, right; Lt, left.


It has not been determined whether a surgical approach is needed in the treatment for TPF [7]. It was also suggested that the management of the aftereffects related to instability in the future is important as it can cause symptoms related to unexpected but clinically important spinal instability if adequate treatment is not performed [8].

Our case report presented a case of lumbar TPF in a patient hospitalized for a short period of time whose pain and physical function improved with iKM treatments. Acupuncture can relieve pain clinically in the injured area and mediate analgesia through the administration of opioid peptides and their receptors. Moreover, it is also commonly used for managing both acute and chronic pain [9]. Shinbaro-pharmacopuncture involves an extract purified from a mixture of six traditional Korean herbal medicines (Table 2) that have been traditionally used for treating various inflammatory and bone diseases. When injected into the fracture sites, this treatment can suppress inflammation, relieve pain, and improve functioning [10]. Dangguisusan-gamibang is an herbal medicine that is an enhanced version of Dangguisusan with the addition of Harpagophytum procumbens, Drynaria fortunei, and the roots of Asarum sieboldii (Table 3). Moreover, Dangguisusan tends to inhibit inflammatory mediators, including nitric oxide, interleukin-1β, interleukin-6, and tumor necrosis factor-α, and decrease the appearance of subcutaneous hematomas, such as bruises [11]. The analgesic and anti-inflammatory effects are amplified by the addition of three specific herbs [12-14]. While a prior case report has emphasized the anti-inflammatory benefits of the combined treatment with Shinbaro-pharmacopuncture and Dangguisusan [15], further research is needed to establish robust scientific evidence.

A literature review on the treatment of traumatic TPF was conducted using the PubMed database (Supplementary Table 1, Supplementary Fig. 1). A total of 14 articles were identified, of which 9 were case reports, while the rest were mainly articles in the form of a retrospective review (Supplementary Table 2). In Supplementary Table 2, medications, such as corset, brace, nonsteroidal anti-inflammatory drugs, or muscle relaxants, were often used rather than a surgical approach. Some studies have also focused on conservative therapies such as medication or braces. However, considering the economic burden caused by spine service intervention, including general nonsurgical therapy, unnecessary financial burdens have been reported [16]. Varma et al. [17] suggested that the evidence on bracing is limited, emphasizing the need for further research on its impact on patient outcomes, cost-effectiveness, and cognitive function. A systematic review and meta-analysis also revealed that bracing offers no benefit in the conservative treatment of acute thoracolumbar fractures [18]. Furthermore, when considering the side effects of medications, iKM may have advantages for TPF patients.

However, our study has several limitations. First, as a case report, it lacked a control group, which makes it difficult to determine whether the patient’s outcomes were directly related to the treatment, resulting in a relatively low level of evidence. Second, follow-up MRI scans are needed to further evaluate the patient’s outcomes after treatment.

Nevertheless, the findings of this study hold significance as it determined the effectiveness of iKM treatment for lumbar TPF caused by a traffic accident. Our results suggest that iKM treatments could be an alternative conservative treatment for lumbar TPF. Further research with control groups and extended follow-up periods are needed to confirm iKM’s effectiveness and potential for a broader clinical application in TPF treatment.

Conceptualization: JSK, GBL, HWC. Formal analysis: All authors. Investigation: JSK, DYK, DJK, DJY. Methodology: JSK, JSY, IJC. Writing - original draft: JSK, YRY. Writing - review and editing: All authors.

This study did not include any human or animal experimentation; therefore, it was exempt from obtaining ethical approval.

  1. Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat 2012;221:507-536. doi: 10.1111/j.1469-7580.2012.01511.x.
    Pubmed KoreaMed CrossRef
  2. Vleeming A, Schuenke MD, Danneels L, Willard FH. The functional coupling of the deep abdominal and paraspinal muscles: the effects of simulated paraspinal muscle contraction on force transfer to the middle and posterior layer of the thoracolumbar fascia. J Anat 2014;225:447-462. doi: 10.1111/joa.12227.
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  3. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8:817-831. doi: 10.1097/00007632-198311000-00003.
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  4. Bui TT, Nagasawa DT, Lagman C, Jacky Chen CH, Chung LK, Voth BL, et al. Isolated transverse process fractures and markers of associated injuries: the experience at University of California, Los Angeles. World Neurosurg 2017;104:82-88. doi: 10.1016/j.wneu.2017.04.137.
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  5. Philipp LR, Boulter J, Deibert C, Ahmad FU. Isolated transverse process spinal fractures increase the likelihood of incurring visceral and pelvic injuries: a retrospective review at a level-1 trauma center. World Neurosurg 2018;110:e168-e176. doi: 10.1016/j.wneu.2017.10.116.
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  6. Anderson PA, Henley MB, Rivara FP, Maier RV. Flexion distraction and chance injuries to the thoracolumbar spine. J Orthop Trauma 1991;5:153-160. doi: 10.1097/00005131-199105020-00006.
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  8. Alijanipour P, Greif D, Lebwohl NH, Gjolaj JP. Isolated multiple lumbar transverse process fractures with spinal instability: an uncommon yet serious association. Eur Spine J 2020;29:127-132. doi: 10.1007/s00586-019-06105-y.
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  10. Kim WK, Chung HJ, Pyee Y, Choi TJ, Park HJ, Hong JY, et al. Effects of intra-articular SHINBARO treatment on monosodium iodoacetate-induced osteoarthritis in rats. Chin Med 2016;11:17. doi: 10.1186/s13020-016-0089-6.
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  11. Jeon YH, Nam WH, Leem HH, Kim SJ, Yu BW, Son SM. Anti-inflammatory effect and analysis of functional constituents of Dangguisu-san by processing methods. Kor J Pharmacogn 2021;52:192-201. doi: 10.22889/KJP.2021.52.3.192.
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  14. Jeong JC, Kang SK, Youn CH, Jeong CW, Kim HM, Lee YC, et al. Inhibition of Drynariae Rhizoma extracts on bone resorption mediated by processing of cathepsin K in cultured mouse osteoclasts. Int Immunopharmacol 2003;3:1685-1697. doi: 10.1016/j.intimp.2003.08.003.
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  15. Yang M, Ha J, Kim J, Choi H, Lee G, Yoon D, et al. Integrated Korean medicine treatments for infrapatellar bursitis: a case report. J Acupunct Res 2023;40:389-394. doi: 10.13045/jar.2023.00199.
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  16. Peterson A, Behrens J, Salari P, Place H. Isolated thoracic and lumbar transverse process fractures: do they need spine surgeon evaluation? A high volume level I trauma center experience with cost analysis. N Am Spine Soc J 2023;15:100242. doi: 10.1016/j.xnsj.2023.100242.
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  17. Varma S, Tsang K, Peck G. Thoraco-lumbar-sacral orthoses in older people - a narrative literature review. Injury 2023;54:110986. doi: 10.1016/j.injury.2023.110986.
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Article

Case Report

Journal of Acupuncture Research 2025; 42(): 46-52

Published online January 23, 2025 https://doi.org/10.13045/jar.24.0050

Copyright © Korean Acupuncture & Moxibustion Medicine Society.

Integrative Korean Medicine for Pain and Functional Recovery in Lumbar Transverse Process Fractures: A Case Report and Literature Review

Ji-Sun Kim , Gyu-Bin Lee , Hong-Wook Choi , Do-Young Kim , Dong-Jin Kim , Dong-Ju Yoon , Ye-Rim Yun , Ji-Sung Yeum , Ik-Jun Cho

Department of Acupuncture and Moxibustion, Jaseng Hospital of Korean Medicine, Seoul, Korea

Correspondence to:Ji-Sun Kim
Department of Acupuncture and Moxibustion, Jaseng Hospital of Korean Medicine, 536 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea
E-mail: lovemintk@naver.com

Received: October 21, 2024; Revised: November 19, 2024; Accepted: December 5, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The transverse processes function as essential attachment points for the muscles and ligaments surrounding the spine, and transverse process fractures (TPF) are commonly observed in trauma patients, such as those involved in traffic accidents. However, studies investigating the effectiveness of integrated Korean medicine (iKM) treatments for lumbar TPF have been limited. The present study aims to report a case of a traffic accident-induced lumbar TPF treated with iKM, which indicated significant improvement in pain and function. The patient was diagnosed with left TPFs at the L3 and L4 vertebral levels via radiological examination and underwent iKM treatments. After two weeks of iKM hospitalization, the numerical rating scale scores decreased from 5 to 3, the Oswestry Disability Index scores decreased from 53.33 to 35.56, and the EuroQoL-5 dimension scores increased from 0.675 to 0.771. In conclusion, our findings suggest that iKM treatments may be effective for patients with lumbar TPF in terms of pain and functional management.

Keywords: Case reports, Integrated Korean medicine treatment, Lumbar transverse process fracture

INTRODUCTION

Transverse processes are bony projections found on the lateral aspects of the spinal vertebrae. Transverse process fractures (TPF) commonly occur in patients with multiple traumas and may present as isolated injuries or alongside other vertebral fractures affecting the lamina, pedicle, facet joint, or vertebral body [1,2].

Within the framework of the thoracolumbar injury classification, TPF was initially categorized as a minor injury [3]. However, research from trauma centers has suggested that the impact of TPF on spinal dynamics may be more significant than previously thought, which is often more severe than the other types of spinal injuries, despite being frequently underestimated [4]. In many instances, patients are discharged from emergency care with prescriptions for pain management, typically including medications such as paracetamol [5].

Owing to the recent increase in the number of traffic accidents and industrial accidents, the cases of spinal fractures have increased, and the introduction of surgical treatment using metal fixation for vertebral fractures has led to several changes and developments. However, if the fracture is overlooked or unstable fractures are not properly treated, the patients will have poor treatment results [6].

Although many conservative treatments have been performed on TPF cases due to traffic accidents, research on the effectiveness of integrated Korean medicine (iKM) treatments for TPF has been limited. Therefore, we report a case of lumbar TPF caused by a traffic accident whose symptoms improved with iKM treatment.

CASE REPORT

1. Chief complaints and medical history

This study included a 41-year-old female who developed pain from both sides of the lower back to the pelvis after a car accident that occurred while she was riding on a bus on April 22, 2024. She presented with pain and bruising on the left side of her lower back. She had no relevant family history or history of medication use. She visited the hospital for the first time on April 26, 2024, without any treatment history, and was hospitalized from April 29 to May 12.

2. Radiography examination

The radiography scan (on April 26, 2024) of the lower back performed on the first day of visit indicated TPFs at the left L3 and L4 vertebral levels (Fig. 1). Magnetic resonance imaging (MRI) was performed three days later (on April 29, 2024) for additional diagnosis, but no special problems were observed except for TPFs at the left L3 and L4 vertebral levels (Fig. 2).

Figure 1. X-ray image scan of the lumbar spine (April 26, 2024). After the L-spine series (anterior to posterior, lateral, oblique) was taken, transverse process fractures could be observed at the left L3 and L4 vertebral levels, especially in the anterior to posterior (A) and oblique view on one side (B). The yellow arrows indicate the lesion area. No abnormalities were observed in the oblique view on the other side (C) and lateral view (D).
Figure 2. T1-weighted (A–C) and T2-weighted (D–F) magnetic resonance imaging (April 29, 2024). The sagittal section shows the left L3 and L4 TPF (A, D). The axial sections show the left L3 (B, E) and L4 TPF (C, F), respectively. The yellow arrows indicate the lesion area. TPF, transverse process fractures.

3. Treatment

1) Acupuncture therapy

Acupuncture was used for pain management (Table 1).

Table 1 . Summary table of interventions used in this study according to the Standard for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA).

ItemDetail
1. Acupuncture rationale1a) Style of acupunctureTraditional Korean acupuncture
1b) Reasoning for the treatment providedLiterature and clinical experience of experts
2. Details of needling2a) Number of needle insertions per subject per sessionFrom 5 to 10
2b) Name of points usedHuatuo Jiaji (EX-B2) points (low back), GV3 (Yaoyangguan) acupoint
2c) Depth of insertion30–35 mm
2d) Response soughtAcupuncture sensation “De qi”
2e) Needle stimulationManual stimulation
2f) Needle retention timeAt once
2g) Needle typeSterile 0.25 × 40 mm stainless needles (Dongbang Acupuncture Inc.)
3. Treatment regimen3a) Number of treatment sessions28
3b) Frequency and duration of the treatment sessionsTwice a day for 10–15 min (14 d)
4. Other components of the treatment4a) Details of other interventions administered to the acupuncture group (e.g., moxibustion, cupping, herbs, exercises, lifestyle advice)Herbal medicine, cupping therapy, and electronic moxibustion
4b) Setting and context of the treatment, including instructions to practitioners and information and explanations to patientsProcedure of the treatments
5. Practitioner background5a) Description of the participating acupuncturists (qualification of professional affiliation, years in acupuncture practice, other relevant experience)Korean medicine doctor of the acupuncture and moxibustion department with more than 6 months of experience
6. Control or comparator interventions6a) Rationale for the control or comparator in the context of the research question, with sources that justify this choiceNo control or comparator interventions
6b) Precise description of the control or comparator. If sham acupuncture or any other type of acupuncture-like control is used, provide details as for Items 1 to 3 aboveNo control or comparator interventions


2) Pharmacopuncture therapy

The patient was also treated with Shinbaro 2 pharmacopuncture (Jaseng Wonoe Tangjunwon) once a day (2 mL/day) using a 1-mL insulin syringe with a disposable needle (29 gauge × 13 mm). The needles were inserted into a depth of 1 cm, and the drug was administered at 0.5 mL per BL25 acupoint. To prevent infection, the treatment site was disinfected with a 10% povidone-iodine solution before and after the procedure (Table 2).

Table 2 . Contents of the Shinbaro-pharmacopuncture used in this study.

Pharmacopuncture prescriptionHerbal medicine components (g/mL)AdministeredDaily dose
SJ3-SBO Shinbaro 2Paeonia lactiflora (0.0027)
Ostericum koreanum (Max) Kitagawa (0.0013)
Aralia continentalis (0.0013)
Cortex Eucommiae (0.0013)
Achyranthis Radix (0.0013)
Rhizoma Cibotii (0.0013)
Radix Ledebouriellae (0.0013)
Acanthopanacis Cortex (0.0013)
Scolopendra subspinipes mutilans (0.0013)
Day 1 to day 141 vial (2 mL/vial)


3) Herbal medicine

Dangguisusan-gamibang, which is used to treat patients with trauma injuries, was prescribed twice daily. Table 3 shows the herbal components, daily doses, and schedules.

Table 3 . Herbal medicine prescriptions.

Herbal prescriptionHerbal medicine components (g/pouch)AdministeredDaily dose
Dangguisusan-gamibangAngelicae Gigantis Radix (4.000)
Paeoniae Radix Rubra (3.200)
Linderae Radix (3.200)
Cyperi Rhizoma (3.200)
Caesalpinia Lignum (3.200)
Carthami Flos (3.200)
Persicae Semen (2.800)
Cinnamon bark (2.400)
Glycyrrhizae Radix et Rhizoma (2.000)
Harpagophytum procumbens (2.000)
Drynaria fortune (2.000)
Roots of Asarum sieboldii (1.200)
Day 1 to day 14Two pouches


4) Other therapy

Transcutaneous infrared irradiation therapy was also applied for 10–15 minutes. Wet cupping therapy applied to the lumbar region and indirect moxibustion therapy were performed for 5–10 minutes twice a day, mainly in the governor vessel and EX-B2 acupoints. For this procedure, sterilized plastic cups (Dongbang Medical Co., Ltd.) and electronic moxibustion (Orange Medical Co., Ltd.) were utilized.

4. Assessments

The numerical rating scale (NRS), Oswestry Disability Index (ODI), and EuroQoL-5 dimension (EQ-5D) were used to evaluate the patient’s lower back pain, functional disability, and quality of life. The NRS pain assessment was conducted at 08:00 AM daily from the day of hospitalization. The ODI and EQ-5D were confirmed by evaluating the hospitalization and discharge dates. The patient’s range of motion (ROM) was evaluated to analyze the mobility of a particular joint. Specifically, we measured the lumbar spine’s movement for flexion, extension, lateral bending, and rotation.

5. Follow-up and outcomes

Upon admission, the patient had an NRS score of 5 for lower back pain, ODI score of 53.33, and EQ-5D score of 0.675. Lumbar spine ROM was noted as flexion of 10, extension of 5, and lateral bending of 20 bilaterally. Both the results of the straight leg raise test and Patrick tests were inconclusive due to pain. On the ninth day of hospitalization, the NRS score decreased to 4. On the discharge day (the 14th day of hospitalization), the NRS score further decreased to 3, ODI score decreased to 35.56, and EQ-5D score was 0.771 (Figs. 35). Moreover, the ROM had slightly improved to a flexion of 60, extension of 10, and lateral bending of 30 bilaterally (Table 4). During hospitalization, no adverse events were observed.

Figure 3. Changes in the NRS scores for lower back pain according to the days of hospitalization. Asterisk indicates the time point when the NRS was initially measured and the time point when a change occurred. NRS, numerical rating scale.
Figure 4. Changes in the ODI score by admission and discharge dates. ODI, Oswestry Disability Index.
Figure 5. Changes in the EQ-5D by admission and discharge dates. EQ-5D, EuroQoL-5 dimension.

Table 4 . Summary table of changes in lumbar range of motion at admission and discharge.

DateFlexion (°)Extension (°)The lat. bending (°)Rotation (°)
RtLtRtLt
2024.04.2910520204545
2024.05.12601030304545

lat., lateral; Rt, right; Lt, left..


DISCUSSION

It has not been determined whether a surgical approach is needed in the treatment for TPF [7]. It was also suggested that the management of the aftereffects related to instability in the future is important as it can cause symptoms related to unexpected but clinically important spinal instability if adequate treatment is not performed [8].

Our case report presented a case of lumbar TPF in a patient hospitalized for a short period of time whose pain and physical function improved with iKM treatments. Acupuncture can relieve pain clinically in the injured area and mediate analgesia through the administration of opioid peptides and their receptors. Moreover, it is also commonly used for managing both acute and chronic pain [9]. Shinbaro-pharmacopuncture involves an extract purified from a mixture of six traditional Korean herbal medicines (Table 2) that have been traditionally used for treating various inflammatory and bone diseases. When injected into the fracture sites, this treatment can suppress inflammation, relieve pain, and improve functioning [10]. Dangguisusan-gamibang is an herbal medicine that is an enhanced version of Dangguisusan with the addition of Harpagophytum procumbens, Drynaria fortunei, and the roots of Asarum sieboldii (Table 3). Moreover, Dangguisusan tends to inhibit inflammatory mediators, including nitric oxide, interleukin-1β, interleukin-6, and tumor necrosis factor-α, and decrease the appearance of subcutaneous hematomas, such as bruises [11]. The analgesic and anti-inflammatory effects are amplified by the addition of three specific herbs [12-14]. While a prior case report has emphasized the anti-inflammatory benefits of the combined treatment with Shinbaro-pharmacopuncture and Dangguisusan [15], further research is needed to establish robust scientific evidence.

A literature review on the treatment of traumatic TPF was conducted using the PubMed database (Supplementary Table 1, Supplementary Fig. 1). A total of 14 articles were identified, of which 9 were case reports, while the rest were mainly articles in the form of a retrospective review (Supplementary Table 2). In Supplementary Table 2, medications, such as corset, brace, nonsteroidal anti-inflammatory drugs, or muscle relaxants, were often used rather than a surgical approach. Some studies have also focused on conservative therapies such as medication or braces. However, considering the economic burden caused by spine service intervention, including general nonsurgical therapy, unnecessary financial burdens have been reported [16]. Varma et al. [17] suggested that the evidence on bracing is limited, emphasizing the need for further research on its impact on patient outcomes, cost-effectiveness, and cognitive function. A systematic review and meta-analysis also revealed that bracing offers no benefit in the conservative treatment of acute thoracolumbar fractures [18]. Furthermore, when considering the side effects of medications, iKM may have advantages for TPF patients.

However, our study has several limitations. First, as a case report, it lacked a control group, which makes it difficult to determine whether the patient’s outcomes were directly related to the treatment, resulting in a relatively low level of evidence. Second, follow-up MRI scans are needed to further evaluate the patient’s outcomes after treatment.

Nevertheless, the findings of this study hold significance as it determined the effectiveness of iKM treatment for lumbar TPF caused by a traffic accident. Our results suggest that iKM treatments could be an alternative conservative treatment for lumbar TPF. Further research with control groups and extended follow-up periods are needed to confirm iKM’s effectiveness and potential for a broader clinical application in TPF treatment.

AUTHOR CONTRIBUTIONS

Conceptualization: JSK, GBL, HWC. Formal analysis: All authors. Investigation: JSK, DYK, DJK, DJY. Methodology: JSK, JSY, IJC. Writing - original draft: JSK, YRY. Writing - review and editing: All authors.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare.

FUNDING

None.

ETHICAL STATEMENT

This study did not include any human or animal experimentation; therefore, it was exempt from obtaining ethical approval.

SUPPLEMENTARY MATERIALS

Supplementary data is available at https://doi.org/10.13045/jar.24.0050 .

jar-42-46-supple.pdf

Fig 1.

Figure 1.X-ray image scan of the lumbar spine (April 26, 2024). After the L-spine series (anterior to posterior, lateral, oblique) was taken, transverse process fractures could be observed at the left L3 and L4 vertebral levels, especially in the anterior to posterior (A) and oblique view on one side (B). The yellow arrows indicate the lesion area. No abnormalities were observed in the oblique view on the other side (C) and lateral view (D).
Journal of Acupuncture Research 2025; 42: 46-52https://doi.org/10.13045/jar.24.0050

Fig 2.

Figure 2.T1-weighted (A–C) and T2-weighted (D–F) magnetic resonance imaging (April 29, 2024). The sagittal section shows the left L3 and L4 TPF (A, D). The axial sections show the left L3 (B, E) and L4 TPF (C, F), respectively. The yellow arrows indicate the lesion area. TPF, transverse process fractures.
Journal of Acupuncture Research 2025; 42: 46-52https://doi.org/10.13045/jar.24.0050

Fig 3.

Figure 3.Changes in the NRS scores for lower back pain according to the days of hospitalization. Asterisk indicates the time point when the NRS was initially measured and the time point when a change occurred. NRS, numerical rating scale.
Journal of Acupuncture Research 2025; 42: 46-52https://doi.org/10.13045/jar.24.0050

Fig 4.

Figure 4.Changes in the ODI score by admission and discharge dates. ODI, Oswestry Disability Index.
Journal of Acupuncture Research 2025; 42: 46-52https://doi.org/10.13045/jar.24.0050

Fig 5.

Figure 5.Changes in the EQ-5D by admission and discharge dates. EQ-5D, EuroQoL-5 dimension.
Journal of Acupuncture Research 2025; 42: 46-52https://doi.org/10.13045/jar.24.0050

Table 1 . Summary table of interventions used in this study according to the Standard for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA).

ItemDetail
1. Acupuncture rationale1a) Style of acupunctureTraditional Korean acupuncture
1b) Reasoning for the treatment providedLiterature and clinical experience of experts
2. Details of needling2a) Number of needle insertions per subject per sessionFrom 5 to 10
2b) Name of points usedHuatuo Jiaji (EX-B2) points (low back), GV3 (Yaoyangguan) acupoint
2c) Depth of insertion30–35 mm
2d) Response soughtAcupuncture sensation “De qi”
2e) Needle stimulationManual stimulation
2f) Needle retention timeAt once
2g) Needle typeSterile 0.25 × 40 mm stainless needles (Dongbang Acupuncture Inc.)
3. Treatment regimen3a) Number of treatment sessions28
3b) Frequency and duration of the treatment sessionsTwice a day for 10–15 min (14 d)
4. Other components of the treatment4a) Details of other interventions administered to the acupuncture group (e.g., moxibustion, cupping, herbs, exercises, lifestyle advice)Herbal medicine, cupping therapy, and electronic moxibustion
4b) Setting and context of the treatment, including instructions to practitioners and information and explanations to patientsProcedure of the treatments
5. Practitioner background5a) Description of the participating acupuncturists (qualification of professional affiliation, years in acupuncture practice, other relevant experience)Korean medicine doctor of the acupuncture and moxibustion department with more than 6 months of experience
6. Control or comparator interventions6a) Rationale for the control or comparator in the context of the research question, with sources that justify this choiceNo control or comparator interventions
6b) Precise description of the control or comparator. If sham acupuncture or any other type of acupuncture-like control is used, provide details as for Items 1 to 3 aboveNo control or comparator interventions

Table 2 . Contents of the Shinbaro-pharmacopuncture used in this study.

Pharmacopuncture prescriptionHerbal medicine components (g/mL)AdministeredDaily dose
SJ3-SBO Shinbaro 2Paeonia lactiflora (0.0027)
Ostericum koreanum (Max) Kitagawa (0.0013)
Aralia continentalis (0.0013)
Cortex Eucommiae (0.0013)
Achyranthis Radix (0.0013)
Rhizoma Cibotii (0.0013)
Radix Ledebouriellae (0.0013)
Acanthopanacis Cortex (0.0013)
Scolopendra subspinipes mutilans (0.0013)
Day 1 to day 141 vial (2 mL/vial)

Table 3 . Herbal medicine prescriptions.

Herbal prescriptionHerbal medicine components (g/pouch)AdministeredDaily dose
Dangguisusan-gamibangAngelicae Gigantis Radix (4.000)
Paeoniae Radix Rubra (3.200)
Linderae Radix (3.200)
Cyperi Rhizoma (3.200)
Caesalpinia Lignum (3.200)
Carthami Flos (3.200)
Persicae Semen (2.800)
Cinnamon bark (2.400)
Glycyrrhizae Radix et Rhizoma (2.000)
Harpagophytum procumbens (2.000)
Drynaria fortune (2.000)
Roots of Asarum sieboldii (1.200)
Day 1 to day 14Two pouches

Table 4 . Summary table of changes in lumbar range of motion at admission and discharge.

DateFlexion (°)Extension (°)The lat. bending (°)Rotation (°)
RtLtRtLt
2024.04.2910520204545
2024.05.12601030304545

lat., lateral; Rt, right; Lt, left..


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Jan 07, 2025 Volume 42:1~130

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