Thirty-eight cases of a "tear drop" fracture of the lower cervical spine treated in our department during the last 20 years are reported. They represent 8.3% of all cervical injuries. We classified our cases into four types with regard to the extent of the bony lesion and the resulting posterior displacement of the vertebral body. Posterior displacement is of paramount importance. Neurological lesions were present in 52.6% of the patients, and they were related to the type of injury. Five patients died, and 33 were followed up for a mean period of 10 years. Five patients were operated on. All patients with a complete neurological lesion remained unchanged irrespective of the type of treatment. Incomplete neurological lesions showed a better tendency to recover after surgical treatment. Types III and IV are the more serious lesions, and they represent an absolute indication for surgical treatment. Type I is more benign and, if treated properly, has a good prognosis similar to type II.