Sagittal fracture of the cervical vertebral body

The sagittal fracture of the cervical vertebral body is an uncommon injury producing the paradoxic situation of profound quadriplegia with either normal or minimal radiographic findings and may be overlooked if polytomography or computed tomography (CT) is not performed. The sagittal fracture was the sole fracture of the vertebral body in seven cases encountered in a review of 270 consecutive cervical fractures, and was readily apparent on routine anteroposterior radiographs in two cases, suspected in two cases, but clearly demonstrated in all cases by polytomography or CT. Most (five of seven) occurred with multiple levels of sagittal fractures in which only one case was apparent on routine radiographs. Posterior ring fractures at the lamina or pedicle were commonly present (six of seven), but detected by plain radiographs in only two cases. The sagittal fracture is frequently a component of the teardrop fracture, occurring in 44% (51/116) of teardrop fractures that were additionally reviewed. The plain radiographic findings are emphasized, since they provide the initial clues as to the presence of this injury. Computed tomography and polytomography either confirmed the presence of or detected additional sagittal fractures, as well as determined the presence of frequently associated arch fractures, and should be used if the plain film findings are uncertain, especially if there is quadriplegia present.