Thoracic spine teardrop fracture – A case report

This is a case report of a young man who suffered from an anterior inferior angle fracture (teardrop) of the thoracic spine at the dorsal spine third vertebra (D3). It was due to a road traffic accident and led to paraplegia and hypoesthesia below D7 dermatome. The patient was treated with decompression and posterior stabilization using pedicle screw fixation followed by physiotherapy. Teardrop fracture is a type of cervical fracture that is associated with high morbidity and mortality due to its instability, with no reported similar fracture pattern at the thoracic spine level. This is a unique case of a thoracic teardrop fracture that was treated surgically with a posterior approach, a good clinical outcome, and 18 months follow-up.

Teardrop Fracture of the Axis: An Evaluation of Vertebral Instability and Individualized Treatment

Background: Teardrop fractures of the axis (TDFAs) are avulsion fractures of the anterior-inferior part of the axis. Whether conservative or surgical treatment is better for TDFAs is controversial. Previously, image-based evaluations of the fractures have mainly focused on the teardrop fragment, the intervertebral disc and the prevertebral soft tissue. The treatment plan depends on the doctor's evaluation of fracture stability based on personal experience. Methods: From January 2012 to December 2018, a total of 12 patients with TDFA were included in this prospective study. The stability of the TDFA vertebral body was evaluated by lateral X-ray measurements. Based on the evaluation of vertebral body stability, as well as the disease characteristics of the patients, individualized treatment schemes were adopted. Results: Through the classification and treatment process, 6 patients with absolute instability and 6 patients with relative instability were identified. A total of 8 patients underwent surgery, and 4 patients were treated conservatively. A total of 12 patients finally achieved osseous fusion. Conclusion: The treatment for TDFA should be determined by considering both the instability of the axial vertebra and the disease characteristics of the patient. With an appropriate classification and treatment process, both surgery and conservative treatment can yield good clinical outcomes.

Anterior Hollow Screw Fixation Combined with Posterior Lateral Mass Screws Fixation to Treat A Huge Tear Drop Fracture of The Axis

Teardrop fracture of axis is rarely seen, especially the huge type. The surgical approach is controversial and individualized in the literature. We reported a special case to share our experience of anterior hollow screw fixation combined with posterior unilateral lateral mass screws fixation to treat a huge teardrop fracture of the axis (HTDFA). A 42-year-old male was referred to our department; he presented neck pain after a vehicle accident. Neck movement was limited with no neurological compromise. Cervical x-rays showed a huge tear drop fracture of the anterior–inferior corner of the axis，the lower cervical spine degeneration and poor cervical curvature. Cervical CT confirmed the avulsed ratio of inferior endplate of axis up to 62%. Cervical MRI showed the anterior longitudinal ligament disruption associated with disk injury and instability of C2-3. In order to save the motion segment of C2-3 and decrease the possibility of lower cervical degeneration if C2-3 fusion occurs, a surgical plan involving anterior reduction, hollow screw fixation combined with posterior unilateral mass screws fixation was performed. The 3 months postoperative x-ray and CT scan showed the tear drop fragment had completely healed. The internal fixations were removed timely for 6 months after surgery. The patient had an excellent function of cervical spine without any clinical symptoms. The 12 months postoperative X-ray showed radiographic union of the bony fragment and a good motion range without any instability. We conclude that anterior hollow screw fixation combined with posterior unilateral lateral mass screws fixation can be the treatment of choice for HTDFA