Updated: 6/23/2021

Extension Teardrop Fracture Cervical Spine

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  • summary
    • Extension Teardrop Fractures of the cervical spine are subaxial cervical spine fractures caused by forced extension of the neck with resulting avulsion of the anteroinferior corner of the vertebral body.
    • Diagnosis can be made with lateral radiographs of the cervical spine. 
    • Treatment is usually immobilization in a hard collar as the injury is mechanically stable.
  • Epidemiology
    • Incidence
      • rare
  • Etiology
    • 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
    • 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
  • Presentation
    • Symptoms
      • neck pain
    • Physical exam
      • patients are usually neurologically intact
      • may have symptoms of central cord syndrome
  • Imaging
    • 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
  • Treatment
    • Nonoperative
      • immobilization in hard collar
        • indications
          • most injuries

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