Extension Teardrop Fracture of Cervical Spine

General Considerations

• Fracture of the cervical spine caused by the sudden pull of the anterior longitudinal ligament on the anterior, inferior aspect of the vertebral body following extreme hyperextension of the neck
• Usually involves C2
  • Anterior longitudinal ligament inserts on anteroinferior aspect of C2
• Fracture of C2 is stable in flexion and unstable in hyperextension
  

Clinical Findings

• Neck pain
• Tenderness to palpation, especially posteriorly
• Limited range of motion
  

Imaging Findings

• As a screen, the lateral radiograph of the cervical spine will demonstrate 85-90% of cervical spine injuries
  • All 7 vertebral bodies should ideally be demonstrated
• CT has replaced conventional radiography in many cases and should be done if the conventional radiographs are normal but there is a high suspicion of cervical spine injury
• Triangular avulsion of the anteroinferior aspect, usually of C2
• No loss of stature of the vertebral body
• Vertical height of the fracture is greater than its width
• Prevertebral soft tissue swelling
  • As a rule of thumb, the soft tissue anterior to C3 should be less than 1/2 of the AP diameter of C3 and the soft tissue anterior to C6 should be less than 2/3 of the AP diameter of C6
    

Differential Diagnosis

• Flexion teardrop fracture also involves anteroinferior aspect of vertebral body
  • Unlike extension injury, this is not an avulsion fracture but an injury caused by compression of the anterior aspect of the vertebral body
• Associated with severe ligamentous injury and loss of stature of the anterior aspect of the vertebral body
• Serious fracture
• Occurs at lower cervical levels
• Unstable and frequently associated with spinal cord injuries 

Treatment

• Neck collar
• Restriction of activity

Complications

• Cervical myelopathy

Prognosis

• Good

Extension Teardrop Fracture of the Cervical Spine. Lateral radiograph of the cervical spine shows a small triangular fragment of bone avulsed from the anterior, inferior border of C3 (white arrow). There is no associated Hangman's fracture.
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Fracture of the Cervical Spine  eMedicine  Moira Davenport, MD; Jorma B Mueller, MD; Emilio Belaval, MD; Simon P Roy, MD