Hyperflexion Teardrop Injury

Hyperflexion Teardrop Injury

CT – Sagittal recontructed image shows reversal of cervical lordosis, anterior translation of C4 relative to C5, anterior wedging of the C5 vertebral body and mild fanning of the posterior elements. Axial images demonstrate the sagittal vertebral body fracture and right pedicolaminar fractures with involvement of the vertebral artery foramen.

Burst fractures and hyperflexion teardrop fractures are likely variations of the same injury.

A burst fracture results in comminution of the vertebral body with the predominant fracture line in the sagittal plane and retropulsion of the posterior-superior corner into the spinal canal. Fractures of the posterior elements are also invariably present. Cervical lordosis is straightened but not reversed. Cord injury is variable depending upon the degree of canal compromise by the retropulsed fragment.

Hyperflexion teardrop fractures are associated with posterior distraction and consequently fanning of the posterior elements and reversal of cervical lordosis. Hyperflexion teardrop injuries are associated with acute anterior cord syndrome (immediate quadriplegia, loss of pain, and loss of temperature and touch sensations but preserved proprioception and vibration sensation). The anterior and posterior longitudinal ligaments and intervertebral disc are disrupted. The distraction of the posterior elements tears the posterior ligament complex leading to subluxation or dislocation of the facets.

Harris JH and Mirvis SE. The Radiology of Acute Cervical Spine Trauma, 3rd Ed (1996).