Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Clin Neurol Neurosurg. 2020 Dec;199:106280. doi: 10.1016/j.clineuro.2020.106280. Epub 2020 Oct 6.
Unilateral subaxial non-subluxed facet fractures (USNSFF) are a pathology seen in traumatic events such as motor vehicle accidents. Management involves either rigid collar bracing or surgical intervention. There currently is no consensus on the treatment of these injuries; this review aims to examine the extant data for recommendations as to which treatment is more effective.
MEDLINE, Scopus, and the Cochrane trial register were all searched on January 16, 2020, comparing outcomes for surgical and conservative therapy for USNSFF. The meta-analysis examined rates of treatment failure (need for subsequent operative management) in conservative versus surgical management. The meta-analysis was performed using a random effects model, with visualization in forest and L'Abbé plots.
We identified six retrospective studies describing 270 patients, with three studies describing 137 patients used in the meta-analysis. Overall, a surgical success rate of 97.7 % and a non-operative success rate of 79.7 % was observed. A random effects model risk ratio of 1.66 (95 % CI: 0.61-4.52) was obtained, suggesting efficacy of surgical management over conservative management.
The need for surgical intervention subsequent to initial management in the treatment of USNSFF was found to be lower in surgical treatment in contrast to conservative management. However, the studies that were included in the meta-analysis had patient cohorts with much higher rates of neurological deficit and ligamentous injury on presentation, indicating that these may be prognostic indicators of conservative management failure. Furthermore, those that did fail conservative management did not develop severely debilitating conditions. Accordingly, conservative treatment is generally sufficient as a first step in a majority of cases of USNSFF lacking neurological deficit or ligamentous involvement.
单侧下颈椎非半脱位关节突骨折（USNSFF）是一种创伤性疾病，多见于交通事故等。其治疗方法包括硬领固定或手术干预。目前对于这种损伤的治疗方法尚无共识，本综述旨在检查现有的数据，以提供更有效的治疗建议。
2020 年 1 月 16 日，我们通过 MEDLINE、Scopus 和 Cochrane 试验注册中心检索了比较 USNSFF 手术和保守治疗结果的文献。荟萃分析检查了保守治疗与手术治疗的治疗失败率（需要后续手术治疗）。荟萃分析采用随机效应模型，以森林图和 L'Abbé 图进行可视化。
我们共确定了 6 项回顾性研究，共描述了 270 例患者，其中 3 项研究共描述了 137 例患者纳入荟萃分析。总体上，手术成功率为 97.7%，非手术成功率为 79.7%。随机效应模型的风险比为 1.66（95%CI：0.61-4.52），表明手术治疗比保守治疗更有效。
与保守治疗相比，在 USNSFF 的初始治疗后，手术治疗需要再次手术干预的情况较少。然而，纳入荟萃分析的研究中，患者队列在就诊时神经功能缺损和韧带损伤的发生率更高，这表明这些可能是保守治疗失败的预后指标。此外，那些保守治疗失败的患者并没有发展出严重致残的情况。因此，在大多数无神经功能缺损或韧带受累的 USNSFF 病例中，保守治疗通常是首选的第一步。
