Subaxial Cervical Vertebral Body Fractures

Introduction

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 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 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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