Table 4 CT features differentiating flexion teardrop from burst fractures
From: MDCT of acute subaxial cervical spine trauma: a mechanism-based approach
Flexion teardrop (Fig. 8) | Burst fracture (Fig. 10) |
|---|---|
Biomechanics—severe compressive flexion | Axial loading |
Predominantly anterior VB compression—resulting in wedging | VB compression predominantly in the centre—resulting in diffuse loss of height |
Oblique coronal fracture through the anteroinferior vertebral body. Fracture does not extend to the posterior cortex and posterior cortical line is intact (sagittal CT) | Fracture involves both anterior/posterior cortex with disruption of posterior cortical line (sagittal) |
Comminution less severe—two/three fragments without centrifugal displacement (axial) | Comminution—severe with multiple fragments and centrifugal displacement |
Retropulsion of the involved vertebral body along the rest of the suprajacent cervical spine Anterior fragment maintains alignment with the subjacent VB (sagittal/axial) | Retropulsion commonly from the postero-superior cortex (sagittal/axial) Rest of the spine above and below maintains alignment |
Focal kyphosis | Normal curvature |
Posterior column often distraction present—interspinous widening and facet distraction | Posterior column compression injury or normal |
Mechanically unstable needs surgical stabilisation | Mechanically stable. Surgical treatment indicated for neural compromise from retropulsed bony fragments |