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Neuroradiology Case of the Week

Case 424

July 2009

Hisao Nakamura, MD

Clinical Presentation: Patient is a 73-year-old female with a history of motor vehicle collision.

Imaging Findings: Extensive tear drop fracture with anterior longitudinal ligament injury.

Diagnosis: Extension tear drop fracture

Discussion: The extension tear drop fracture (ETDF) is an avulsion fracture at the site of attachment of the anterior longitudinal ligament. It involves the anterior inferior aspect of the vertebral body. Typically, it occurs in elderly osteoporotic patients and is associated with little or prevertebral hematoma. The typical ETDF fractures most commonly affect C2. As opposed to the avulsed fragment seen in hyperextension dislocation, the vertical height of the ETDF fragment is equal or exceeds its transverse dimension. There is high incidence of coexisting lesions at the same or at more distal levels. The typical C2 ETDF is usually mechanically and neurologically stable. In young adults, a variant of ETDF may occur in the lower cervical spine. When this ETDF variant is associated with massive prevertebral soft tissue swelling, 80% of patients have an acute central cord syndrome. As in the present case, ETDF is associated with ALL injury, without cord lesion.
     Differential diagnosis includes flexion tear drop fracture (FTF). FTF has the characteristics that there is a large triangular fragment and posterior elements are distracted, which make them ETDF differentiated.

References:

1. Schwartz ED, Flanders AE. Spinal Trauma: Imaging, Diagnosis, and Management. Lippincott Williams and Wilkins. 2006: 139-140.