Updated: 1/18/2018

Extension Teardrop Fracture Cervical Spine

Review Topic
  • Subaxial cervical fracture pattern caused by forced extension of the neck with resulting avulsion of the anteroinferior corner of the vertebral body
  • Pathophysiology
    • extension mechanism causes disruption of the anterior longitudinal ligament (ALL)
    • represents a true avulsion often of an anterior osteophyte
      • distinguish from a flexion teardrop fracture
        • larger fragment produced by compression
    • extension teardrop fractures are stable in flexion, and unstable in extension
      • not considered as severe as flexion teardrop fractures
  • Epidemiology
    • incidence
      • rare
  • Associated conditions
    • central cord syndrome 
      • buckling of the ligamentum flavum into canal during hyperextension phase of injury
      • risk factors
        • elderly
          • anterior osteophytes and posterior infolded ligamentum flavum
    • can be seen in diving accidents
    • not usually associated with spinal cord injuries
  • Symptoms
    • neck pain
  • Physical exam
    • patients are usually neurologically intact
    • may have symptoms of central cord syndrome 
  • Radiographs 
    • recommend views
      • AP and lateral of cervical spine
    • findings
      • avulsion fracture from attachment of the ALL to the inferior corner of the vertebral body 
        • usually a thin fracture fragment
        • fragment is usually triangular in shape - reminiscent of a teardrop
        • may see anterior disc space widening
  • MRI
    • may help distinguish extension injury from flexion injury
    • edema will be located anteriorly in extension injury
  • Nonoperative
    • immobilization in hard collar
      • indications
        • most injuries

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