Risk Factors for Failure of Non-operative Management in Isolated Unilateral Non-displaced Facet Fractures of the Subaxial Cervical Spine: Systematic Review and Meta-Analysis

Ignacio Cirillo; Guillermo Alejandro Ricciardi; Juan Pablo Cabrera; Felipe Lopez Muñoz; Lyanne Romero Valverde; Andrei Joaquim; Charles Carazzo; YURAC BARRIENTOS, RATKO JOVAN

doi:10.1177/21925682241304351

Risk Factors for Failure of Non-operative Management in Isolated Unilateral Non-displaced Facet Fractures of the Subaxial Cervical Spine: Systematic Review and Meta-Analysis

Journal

Global Spine Journal

ISSN

2192-5682

2192-5690

Date Issued

2024

Author(s)

Ignacio Cirillo

Guillermo Alejandro Ricciardi

Juan Pablo Cabrera

Felipe Lopez Muñoz

Lyanne Romero Valverde

Andrei Joaquim

Charles Carazzo

YURAC BARRIENTOS, RATKO JOVAN

Facultad de Medicina Clínica Alemana Universidad del Desarrollo

Type

journal-article

DOI

10.1177/21925682241304351

URL

https://investigadores.udd.cl/handle/123456789/10464

Abstract

Study Design systematic review. Objective To evaluate risk factors associated with failure of non-operative management of isolated unilateral facet fractures of the subaxial cervical spine in neurologically intact patients. Methods A systematic review of the PubMed, Embase, LILACS, and Cochrane Library databases was conducted in order to determine risk factors associated with failure of non-operative management in isolated unilateral facet fractures of the subaxial cervical spine without facet and/or vertebral displacement, in neurologically intact patients. Our research was in line with the PRISMA Statement and registered on PROSPERO (CRD42023405699). Results A total of 1639 studies were identified through a database search on May 5, 2023. In total, 7 studies from the databases were included, along with 1 study found through a manual citation search. The evidence showed high clinical heterogeneity, a serious risk of bias according to the ROBINS-I tool, and a predominance of retrospective cohort studies. In comparison to less complex facet fractures, lateral floating mass fractures were found to have 5.41 times higher odds of failure of non-operative management (OR = 5.41; 95% CI = 1.32, 22.19). We calculated the potential association between lower absolute fracture height and non-operative treatment success [Fracture height (percentage) Mean Difference = −17.51 (−28.22, −6.79 95% CI); Absolute height Mean Difference: −0.46 (−0.60, −0.31 95% CI)]. Other risk factors were not included in the meta-analysis due to lack of data. The level of certainty was rated as “very low”. Conclusions Lateral floating mass cervical facet fractures and larger fracture fragment size (measured either in absolute terms or as a percentage) are significant risk factors for failure of non-operative treatment.