C3-C7 Spine Fractures

Author: Michelle Lin, MD
Updated: 10/1/2010

Fractures, C3-C7 Spine

Articular mass fractures

Mechanism Stable
Flexion-rotation Yes
  • Associated with transverse process and vertebral body fractures
  • Uncommon

Burst fractures

Mechanism Stable
Axial compression Yes/No
  • Compressive fracture of the anterior and posterior vertebral body
  • Complication: Spinal cord injury because of retropulsed vertebral body fragment (especially anterior cord syndrome)

Spinous process fracture (“Clay Shoveler’s" fracture)

Mechanism Stable
Flexion Yes
  • Spinous process fracture from forceful neck flexion
  • Most commonly occurs in lower cervical levels (C7)
  • Not associated with neurologic injury

Extension teardrop fracture

Mechanism Stable
Extension No
  • See Fracture, C1 and C2 spine topic
  • Most commonly occurs at C2

Facet dislocation, bilateral

Mechanism Stable
Flexion No
  • Significant anterior displacement (>50%) of spine when bilateral inferior facets displace anterior to the superior facets below
  • At risk for injuring anterior and posterior longitudinal ligament, disk, vertebral arteries, and spinal cord

Flexion dislocation, unilateral

Mechanism Stable
Flexion-rotation Yes
  • Usually causes 25-50% anterior displacement of spine
  • Complication: Vertebral artery injury (CT angiography recommended)

Flexion teardrop Fracture

Mechanism Stable
Flexion and axial load No
  • Fracture and anterior displacement of anteroinferior vertebral body (appears similar to extension teardrop fracture, except much more unstable)
  • Rupture of both anterior & posteior ligamentous complexes
  • Unique findings for flexion (versus extension) teardrop fx: Same-level fxs, displacement of posterior structures
  • Regarded as ONE OF THE MOST UNSTABLE FX's in the lower cervical spine, because involves both columns
  • Usually occurs at C5 or C6

Subluxation, anterior

Mechanism Stable
Flexion No
  • Ruptured posterior ligamentous complex, such that anterior and posterior vertebral lines are disrupted
  • Complication: vertebral artery dissection (CT angiography recommended)
  • May only be evident during flexion views by conventional xray; the interspinous distance widens and the vertebral body subluxes anteriorly

Transverse Process Fracture

Mechanism Stable
Lateral flexion Yes
  • Complication: Vertebral artery injury, because travels within the transverse foramina (CT angio recommended)
  • Complication: Cervical radiculopathy and brachial plexus injuries associated in 10% of cases

Wedge Fracture

Mechanism Stable
Flexion Yes
  • Compression fracture of only the anterosuperior vertebral body endplate
  • Disruption of anterior vertebral line
Injury (Mechanism) Stable
Articular mass fx (Flexion-rotation) Yes
Burst fx (Axial compression) Yes/No
Spinous process fx (Flexion) Yes
Extension teardrop fx (Extension) No
Facet dislocation, bilateral (Flexion) No
Flex dislocation, unilateral (Flexion-rotation) Yes
Flexion teardrop fx (Flexion and axial load) No
Subluxation, anterior (Flexion) No
Transverse process fx (Lateral flexion) Yes
Wedge fx (Flexion) Yes

C3-C7 fracture diagram


  • Lin M and Mahadevan S. “Spine and Spinal Cord Injuries” in Adams J et al (eds), Emergency Medicine Clinical Essentials. New York: Elsevier, 2007