Updated: 2/11/2019

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
  • Fracture patterns vary by mechanism and include
    • 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
  • Symtoms
    • incomplete vs. complete cord injury
  • Must determine if there is a posterior ligamentous injury so MRI often important
  • 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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