Clinics in diagnostic imaging (192). Flexion teardrop fracture

Abstract

An 82-year-old woman presented with neck pain and bilateral upper limb paraesthesia after sustaining an unwitnessed fall at home the day before. Physical examination revealed tenderness over the C4-6 region but no evidence of step deformity or neurological deficit. Magnetic resonance imaging of the cervical spine revealed multiple small fractures at the anteroinferior endplate corners of the C3, C5 and C6 vertebrae with focal kyphosis and marrow oedema at these levels, as well as associated disruption of the anterior longitudinal ligament and central spinal canal stenosis. The diagnosis of multiple flexion teardrop fractures was made based on these imaging findings, and the patient subsequently received conservative management. This paper illustrates the radiological features of flexion teardrop fractures and highlights the importance of prompt diagnosis and management of such cases.

Keywords: cervical spine injury; flexion teardrop fracture; magnetic resonance imaging; vertebral fracture.

Fig. 1

(a) Plain lateral radiograph of the cervical spine. (b) Unenhanced sagittal CT image of the cervical spine in bone window.

Fig. 2

Contiguous sagittal inversion recovery MR images of the cervical spine in (a) midline and (b) lateral view.

Fig. 3

(a & b) Sagittal T2-W MR images of the cervical spine of a 64-year-old motor vehicular accident victim show disruption of the anterior longitudinal ligament as a result of a C4 flexion teardrop fracture (arrows denote the separate ends) with resultant pre-vertebral haematoma (arrowheads).

Fig. 4

(a) Sagittal T2-W and (b & c) axial MR images of the cervical spine of a 67-year-old man after an unwitnessed fall. As a result of a C4 flexion teardrop fracture, there is disruption of the anterior longitudinal ligament at C4–5 and C5–6 with periligamentous oedema and fluid tracking into the exposed intervertebral disc spaces (arrows). Heterogeneity and raised signal of the interspinous ligaments at these levels indicates associated injury. Compression of the spinal cord at the C5 level (curved arrow) secondary to the C4/C5 retrolisthesis with resultant cord oedema (arrowheads) is seen.