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Journal of Bone and Joint Surgery, 1956;38:985-997.
© 1956 by The Journal of Bone and Joint Surgery, Inc

Chronic Neurological Sequelae of Acute Trauma to the Spine and Spinal Cord

The Significance of the Acute-Flexion or "Tear-Drop" Fracture-Dislocation of the Cervical Spine

Richard C. Schneider M.D.1 and Edgar A. Kahn M.D.1

1 Section of Neurosurgery, Department of Surgery, University of Michigan Medical School and Hospital, Ann Arbor

The acute-flexion or tear-drop fracture-dislocation associated with injuries of the cervical spinal cord warrants special attention. It is characterized by the separation and downward and forward displacement of the anterior inferior margin of the involved vertebral body. The posterior inferior margin of this same vertebral body is displaced posteriorly into the spinal canal.

Acute injuries of this type may be associated with the syndrome of damage to the anterior aspect of the cervical cord. This syndrome may be due to either destruction of this portion of the cord or to compression by displaced bone or disc material. If due to compression, this may be relieved by a surgical procedure.

In these cases surgical exploration with the patient in traction and section of the dentate ligaments are indicated, if neurological signs are present. Spine fusion should then be performed at the primary operation, or at a secondary procedure. This will prevent

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instability of the spine, and the fractured cervical vertebrae will heal in good alignment without the formation of a bony bulge posteriorly. Such bulging may cause chronic compresion of the anterior portion of the cervical spinal cord with neurological sequelae. If the tear-drop fracture is present without neurological signs, spine fusion without laminectomy should be performed after spinal re-alignment by cervical traction.


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