Reducing the cervical flexion tear-drop fracture with a posterior approach and plating technique: an original method

Flexion tear-drop fractures (FTDF) in the cervical spine constitute a highly unstable condition with a high incidence of neurological complications due to posterior displacement of the fractured vertebra in the spinal canal. The widely accepted surgical management for this condition includes complete excision and grafting of the vertebral body through an anterior approach. Thorough radiological and CT analysis of FTDF shows that the vertebral body is often separated into two parts by a sagittal plane fracture, but remains continuous through the pedicle and anterior arch of the vertebral foramen with the lateral mass and the articular processes. We therefore hypothesized that reduction would be possible by acting on the articular process through a posterior approach with a particular plating technique. Eight patients with FTDF were operated on with the technique we describe. Three had complete tetraplegia, four had incomplete tetraplegia and one was normal. A preoperative CT scan was made in all patients. Local kyphosis, posterior displacement of the vertebral body, and general lordosis in the cervical spine were recorded. In all cases, a satisfactory reduction was achieved on the postoperative radiographs and at the mean follow-up of 18.6+/-12.1 months, with residual posterior displacement being less than 1 mm. No complication occurred. Out of seven neurologically impaired patients, five showed some motor recovery at the latest follow-up. The posterior technique is described, and the rationale and pros and cons are discussed. The study showed that posterior reduction and fixation of flexion tear-drop fracture is not only possible, but permits an accurate restoration of the anatomy of the fractured cervical spine.