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

Abstract

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.