Flexion-distraction injuries are caused by flexion of the spine around an anterior fulcrum. This fulcrum may be within the anterior column, or anterior to this as in a Chance fracture.

Radiologically, there is separation of the posterior elements and compression of the anterior column. These commonly occur from lap-belt injuries in cars, and typically affect the thoraco-lumbar junction. There is a high incidence of associated intra-abdominal injury.