Clinical features of the extension teardrop fracture of the axis: review of 13 cases

Object Extension teardrop fracture of the axis is an extremely rare cervical spinal injury. The classic clinical features, which have mainly been described by radiologists rather than spine surgeons, include its occurrence in elderly patients with osteoporosis, an association with minimal or no prevertebral soft-tissue swelling, and an absence of associated neurological deficit. However, recent case studies indicate notable exceptions to these clinical features, although few studies have investigated osteoporosis in these patients. The purpose of the present study was to clarify the clinical features of extension teardrop fracture of the axis. Methods The authors retrospectively reviewed data obtained in 13 patients with regard to their injury etiology, neurological deficit, treatment and outcome (residual neck pain), and imaging findings (size and displacement of the fragment, C2–3 subluxation, disc injury, and osteoporosis of the axis). Results Extension teardrop fracture of the axis constituted 11.6% of upper cervical spinal injuries at the authors' institute. The mean age of the patients was 49.5 years and distinct osteoporosis was identified in only 1 patient. A C2–3 subluxation was observed in 2 patients, in whom the displacement of the fragment was significant, although its size did not appear to have an effect. Magnetic resonance imaging, undertaken in 7 patients within 48 hours of injury, showed no disc injuries. Instability of the cervical spine was absent in all patient at follow-up. Only one patient underwent surgery for the presenting symptoms of dysphagia. The other patients were treated conservatively. The authors examined 9 patients directly; these patients had bony fusion and did not complain of neck pain, except for a patient with traumatic spondylolisthesis. Conclusions Extension teardrop fracture of the axis is generally caused by hyperextension of the cervical spine caused by a direct high-energy blow to the forehead or mandible. Based on the present case study, the authors believe that osteopenia and older age should not be considered risk factors. Most patients with an extension teardrop fracture of the axis can be treated conservatively, and surgical intervention may only be indicated for specific cases, such as those in which a patient presents with dysphagia or with other complicated fractures.