Treatment Outcome of Cervical Tear Drop Fracture

STUDY DESIGN This is a retrospective study. PURPOSE We wanted to evaluate the clinical results of surgical and conservative treatment for cervical tear drop fracture. OVERVIEW OF LITERATURE The tear drop fracture of the lower cervical spine is generally associated with a high incidence of neurological deficits and surgery is needed to treat this injury. Tear drop fracture of C2 is usually a stable fracture that is amendable to conservative treatment. METHODS We reviewed the outcomes of 25 patients. Cervical tear drop fracture was classified as the extension and flexion types according to the mechanism of injury. The neurologic symptoms were evaluated by the Frankel classification system, and the loss of lordosis and disc height, and the duration of bony union were analyzed. RESULTS Twenty one patients had the flexion type injury and 4 patients had the extension type injury. All the patients with the flexion type were treated by anterior decompression and plate stabilization. All the patients with the extension type were treated conservatively. Ten patients with the flexion type had neurologic deficits. The nerve root injuries recovered fully and the incomplete injuries had an average 1.5 grade recovery. Radiologically, the extension type fracture showed bony union at an average of 12.8 weeks. For the patients with the flexion type fracture, the loss of lordosis was 2.6 degrees and the loss of disc height was 2.1 mm. The period of bony union in 20 cases was 13.0 weeks. CONCLUSIONS Anterior plate stabilization was an effective treatment for the flexion type tear drop fracture. Conservative treatment is thought to be one of the good clinical methods for treating the extension type tear drop fracture.