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Radiographic Summary

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A true flexion teardrop fracture appears as a small fractured bony fragment at the anteroinferior border of the vertebral body. Generally, these occur at mid-cervical levels, and are three-column injuries with anterior column fractures, disruption of the posterior longitudinal ligament, and facet disruption. On plain radiographs, this injury is best seen on lateral view, with kyphosis and anterolisthesis at the affected level. The most common radiographic features also include prevertebral soft tissue swelling, a triangular anterior vertebral body avulsion fracture (teardrop fragment), posterior vertebral body subluxation, possible vertebral body displacement into the spinal canal, and spinous process fracture.

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Clinical Implications

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Flexion teardrop fractures are the most severe injuries to the cervical spine. They are caused by hyperflexion of the neck with additional compressive forces that result in disruption of the posterior ligaments. Flexion teardrop fractures are highly unstable fractures and may be associated with spinal cord injury in up to 50% of cases. Treatment may include rigid c-collar in certain patient populations that have minimal fracture displacement, minimal kyphosis, no neurologic symptoms, and no posterior longitudinal ligament injury. Otherwise, treatments include a halo or operative intervention.

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Figure 11.1 Flexion Teardrop Fracture.
Graphic Jump Location

Cross-table lateral radiograph of the cervical spine shows a flexion teardrop injury at the C5 level. In addition to the fracture of the anterior, inferior aspect of the C5 vertebral body, there is disruption of the facet joints, with widening and malalignment of the posterior elements between C4 and C5.

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Pearls

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  1. Flexion teardrop fractures are most common at the C5 level.

  2. This particular fracture may be associated with anterior cord syndrome with loss of motor, pain, and temperature sensation, with preservation of proprioception and fine touch.

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Figure 11.2 Flexion Teardrop Fracture.
Graphic Jump Location

Sagittal CT image in a different patient shows a flexion teardrop fracture at C4. Note widening between the C4 and C5 spinous processes and distraction of the C4–C5 disk space.

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Figure 11.3 Flexion Teardrop Fracture.
Graphic Jump Location

Sagittal T2 MR image shows disruption of the C4–C5 disk space and posterior subluxation of the C4 vertebral body. Increased signal within the spinal cord at the level of injury indicates a cord contusion.

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Radiographic Summary

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Extension corner avulsion fractures result from avulsion of the anterior longitudinal ligament from the inferior margin of C2, and are a result of extreme hyperextension. These fractures are sometimes referred to as “extension teardrop” injuries, due to the triangular fracture fragment produced, but should be distinguished from the flexion teardrop fracture pattern. In extension corner avulsion fractures, the alignment of the posterior aspect of the vertebral bodies and the posterior elements remain ...

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