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 neurologic deficits Etiology Types compression fracture characterized by compressive failure of the anterior vertebral body without disruption of posterior body cortex and without retropulsion into spinal 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 incomplete SCI 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 anterior endplate with an avulsion of a small fleck of bone usually occurs 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 the clinical setting based solely on static radiographic appearance and mechanisms of injury six groups represent a spectrum of anatomic disruption and include: flexion-compression vertical compression flexion-distraction extension-compression extension-distraction lateral flexion Radiographic description classification of subaxial spine injuries more commonly used in clinical setting includes: compression fracture burst fracture flexion-distraction injury facet dislocation (unilateral or bilateral) facet fracture Presentation Symptoms incomplete vs. complete SCI Imaging MRI must determine whether there is a posterior ligamentous injury Treatment Nonoperative collar immobilization for 6-12 weeks indications stable mild compression fractures (intact posterior ligaments and no significant kyphosis) anterior teardrop avulsion fracture external halo immobilization indications stable fracture pattern (intact posterior ligaments and no significant kyphosis) Operative anterior decompression, corpectomy, strut graft, and fusion with instrumentation indications compression fracture with 11° of angulation or 25% loss of vertebral body height unstable burst fracture with cord compression unstable teardrop 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 and fusion with instrumentation indications significant injury to posterior elements anterior decompression not required