Presentation
Mountain bike crash over jump. Head strike. Quadriplegia.
Patient Data
Flexion teardrop fracture at C4 consisting of a fracture of the anterior inferior portion of the vertebral body and a sagittally oriented fracture completely through the body. Bilateral non displaced C4 lamina fractures. Coronally oriented fracture of the anterior portion of the C5 vertebral body. Mild focal kyphosis is present at this level and there is mild bilateral C4-5 facet joint widening suggesting facet capsular disruption. The spinal canal remains relatively widely patent. Prevertebral hematoma tracks superiorly from the fracture site.
The MRI study reveals the cause of the quadriplegia to be cord hemorrhage (best seen as the dark signal on the axial GRE sequence) and edema at the level of injury. No cord transection. Mild cord flattening due to canal narrowing. No epidural hematoma. The ALL is torn at the level of the fracture. PLL and posterior portions of the intervertebral discs are intact. There is mild facet capsular injury, low grade C3-4 ligamentum flavum and interspinous ligament injury and C4-5 supraspinous ligament injury.
Case Discussion
Typical appearance of a C4-5 level flexion teardrop fracture and cord hemorrhage. Flexion teardrop fractures are almost always unstable and associated with significant ligamentous and / or cord injuries, unlike extension teardrop fractures which are usually a less severe injury.