BACKGROUND AND OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.

中文翻译：

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单侧轴下非半脱位小关节骨折的手术与保守治疗：系统评价和荟萃分析

背景和目的 单侧轴下非半脱位小关节骨折 (USNSFF) 是一种常见于创伤性事件（例如机动车事故）的病理学。管理涉及刚性衣领支具或手术干预。目前对这些损伤的治疗没有达成共识；本次审查旨在检查现有数据，以提供关于哪种治疗更有效的建议。方法 MEDLINE、Scopus 和 Cochrane 试验注册库均于 2020 年 1 月 16 日进行了检索，比较了 USNSFF 手术和保守治疗的结果。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）。荟萃分析是使用随机效应模型进行的，并在森林和 L'Abbé 图中进行了可视化。结果 我们确定了六项回顾性研究，描述了 270 名患者，其中三项研究描述了荟萃分析中使用的 137 名患者。总体而言，观察到手术成功率为 97.7%，非手术成功率为 79.7%。随机效应模型风险比为 1.66（95% CI：0.61-4.52），表明手术治疗优于保守治疗。结论 与保守治疗相比，USNSFF 初始治疗后手术干预的需求在手术治疗中较低。然而，纳入荟萃分析的研究中，就诊时神经功能缺损和韧带损伤的发生率要高得多，这表明这些可能是保守治疗失败的预后指标。此外，那些确实未能通过保守管理的人并没有发展出严重的衰弱状况。因此，在大多数没有神经功能缺损或韧带受累的 USNSFF 病例中，保守治疗通常足以作为第一步。