Updated: 6/28/2021

Subaxial Cervical Vertebral Body Fractures

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https://upload.orthobullets.com/topic/2018/images/flexion teardrop injury.jpg
https://upload.orthobullets.com/topic/2018/images/Xray-Lateral-Burst fracture_moved.jpg
https://upload.orthobullets.com/topic/2018/images/CT - Sagital - C5 burst fracture_moved.jpg
https://upload.orthobullets.com/topic/2018/images/extension teardrop.jpg
  • summary
    • Subaxial Cervical Vertebral Body Fractures are a subset of cervical spine injuries that consist of compression fractures, burst fractures, flexion teardrop fractures, and extension teardrop avulsion fractures.
    • Diagnosis is made with radiographs of the cervical spine. CT scan can be helpful for fracture characterization and surgical planning. 
    • Treatment can be nonoperative or surgical stabilization depending on fracture pattern, mechanical stability, and the presence of neurological deficits. 
  • Etiology
    • Types
      • compression fracture
        • characterized by
          • compressive failure of anterior vertebral body without disruption of posterior body cortex and without retropulsion into canal
          • often associated with posterior ligamentous injury
      • burst fracture
        • characterized by
          • fracture extension through posterior cortex with retropulsion into the spinal canal
          • often associated with posterior ligamentous injury
        • prognosis
          • often associated with complete and incompete spinal cord injury
        • treatment
          • unstable and usually requires surgery
      • flexion teardrop fracture
        • characterized by
          • anterior column failure in flexion/compression
            • posterior portion of vertebra retropulsed posteriorly
          • posterior column failure in tension
          • larger anterior lip fragments may be called 'quadrangular fractures'
        • prognosis
          • associated with SCI
        • treatment
          • unstable and usually requires surgery
      • extension teardrop avulsion fracture
        • characterized by
          • small fleck of bone is avulsed of anterior endplate
            • usually occur at C2
            • must differentiate from a true teardrop fracture
        • mechanism
          • extension
        • prognosis
          • stable injury pattern and not associated with SCI
        • treatment
          • cervical collar
  • Subaxial Spine Injury Classification
    • Allen and Ferguson classification(of subaxial spine injuries)
      • typically used for research and not in clinical setting
      • based solely on static radiographs appearance and mechanisms of injury
      • six groups represent a spectrum of anatomic disruption and include
        1. flexion-compression
        2. vertical compression
        3. flexion-distraction
        4. extension-compression
        5. extension-distraction
        6. lateral flexion
    • Radiographic description classification (of subaxial spine injuries)
      • more commonly used in clinical setting
      • includes
        • compression fracture
        • burst fraction
        • flexion-distraction injury
        • facet dislocation (unilateral or bilateral)
        • facet fracture
  • Presentation
    • Symtoms
      • incomplete vs. complete cord injury
  • Imaging
    • Must determine if there is a posterior ligamentous injury so MRI often important
  • Treatment
    • Nonoperative
      • collar immobilization for 6 to 12 weeks
        • indications
          • stable mild compression fractures (intact posterior ligaments & no significant kyphosis)
          • anterior teardrop avulsion fracture
      • external halo immobilization
        • indications
          • only if stable fracture pattern (intact posterior ligaments & no significant kyphosis)
    • Operative
      • anterior decompression, corpectomy, strut graft, & fusion with instrumentation
        • indications
          • compression fracture with 11 degrees of angulation or 25% loss of vertebral body height
          • unstable burst fracture with cord compression
          • unstable tear-drop fracture with cord compression 
          • minimal injury to posterior elements
        • early decompression (< 24 hours) has been shown to improve neurologic outcomes compared with delayed (>/ 24 hours) decompression
      • posterior decompression, & fusion with instrumentation
        • indications
          • significant injury to posterior elements
          • anterior decompression not required

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