Flexion tear drop fractures are the most severe fracture of the cervical spine, often causing anterior cervical cord syndrome and quadriplegia.
It typically occurs from severe flexion and compression forces, most commonly at C5-6 (e.g. diving head first, motor vehicle collision deceleration).
- sagittal fracture through the vertebral body
- fracture of the anteroinferior vertebral body (teardrop sign)
- loss of anterior height of the vertebral body
- cervical kyphosis
- posterior cervical displacement above the level of injury
- widening of interspinous processes
- intervertebral disc space narrowing
- disruption of the spinolaminar line
- vertebral body rotation with an AP diameter that appears smaller than on other levels
- anterior dislocation of the facet joints
Further imaging (MRI) of the spinal cord should be performed to investigate possible cord injuries. CTA may be indicated to screen for blunt cerebrovascular injury (BCVI).
The 'teardrop' appears similar to the extension teardrop fracture, both can be represented by an anteroinferior vertebral fragment. However, the extension teardrop is not as severe injury, as the vertebral body is not displaced.
Treatment and prognosis
Due to the disturbance of both the bony and ligamentous structures, this fracture is unstable with almost all patients requiring decompression and stabilisation.The long-term prognosis of this injury is associated with neurologic deficits and quadriplegia 4.
- further MRI imaging is recommended to investigate possible associated cord injuries
There are several other tear drops, please see the disambiguation article here.
- 1. Kim HJ, Lee KY, Kim WC. Treatment outcome of cervical tear drop fracture. Asian Spine J. 2009;3 (2): 73-9. doi:10.4184/asj.2009.3.2.73 - Free text at pubmed - Pubmed citation
- 2. Kim KS, Chen HH, Russell EJ et-al. Flexion teardrop fracture of the cervical spine: radiographic characteristics. AJR Am J Roentgenol. 1989;152 (2): 319-26. doi:10.2214/ajr.152.2.319 - Pubmed citation
- 3. Kim KS, Chen HH, Russell EJ et-al. Flexion teardrop fracture of the cervical spine: radiographic characteristics. AJR Am J Roentgenol. 1989;152 (2): 319-26. AJR Am J Roentgenol (citation) - Pubmed citation
- 4. Kim HJ, Lee KY, Kim WC. Treatment outcome of cervical tear drop fracture. Asian spine journal. 3 (2): 73-9. doi:10.4184/asj.2009.3.2.73 - Pubmed
- fractures by location
- cervical spine fracture classification systems
- thoracolumbar spinal fracture classification systems
- three column concept of spinal fractures (Denis classification)
- classification of sacral fractures
- facet dislocation