This case demonstrates the typical radiographic features found in extension tear-drop fractures of the lower cervical spine. As its name suggests, this type of fracture is produced by forced extension of the neck. There is resulting avulsion of the fibers of the anterior longitudinal ligament off the anteroinferior endplate of the vertebral body. The shape of the avulsed fragment is triangular, with the vertical dimension being equal to, or larger than the transverse dimension.

Whilst a standard x-ray may demonstrate the character of the avulsed fragment and/or soft tissue shadowing associated with this fracture (indicative of pre-vertebral soft tissue swelling), CT is often required to better characterize the fracture and to evaluate for additional injuries. MR imaging is often performed to determine the extent of ligamentous disruption and the presence/extent of spinal cord edema, contusion and/or injury.

Treatment of this type of fracture depends on fragment size, displacement or angulation, intervertebral disc injury, spinal stability and/or neurological deficit(s). This patient was managed conservatively in a hard C-spine collar due to complications from his MSSA septicemia.

Case courtesy of Associated Professor Pramit Phal