summary Extension teardrop fractures of the cervical spine are subaxial cervical spine fractures caused by forced extension of the neck, resulting in 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 important to distinguish from a flexion teardrop fracture flexion teardrop fractures have larger fragments 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 due to buckling of the ligamentum flavum into the canal during the hyperextension phase of injury risk factors elderly patients anterior osteophytes and infolded posterior ligamentum flavum can be seen in diving accidents not usually associated with spinal cord injuries Presentation Symptoms neck pain Physical exam usually neurologically intact may have symptoms of central cord syndrome Imaging Radiographs recommend views AP and lateral of the cervical spine findings avulsion fracture from the attachment of the ALL off 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 a hard collar indications most injuries