Learning Radiology xray montage
 
 
 
 
 

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 

Extension Fractures of the Cervical Spine

Posterior atlantoaxial subluxation

Posterior (neural) arch fracture of C1

Hangman fracture

Extension teardrop fracture

 

Treatment

  • Neck collar
  • Restriction of activity

Complications

  • Cervical myelopathy

Prognosis

  • Good

Flexion Teardrop Fracture

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.
For this same photo without the arrows, click
here
For more information, click on the link if you see this icon

Fracture of the Cervical Spine  eMedicine  Moira Davenport, MD; Jorma B Mueller, MD; Emilio Belaval, MD; Simon P Roy, MD