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Yurac, Ratko

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Subject: Isolated ×

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    Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation: a narrative review and proposed treatment algorithm
    (2024) Cirillo, Juan; Ricciardi, Guillermo; Alvarez, Facundo; Guiroy, Alfredo; Yurac, Ratko; Schnake, Klaus
    Isolated cervical spine facet fractures are often overlooked. The primary imaging modality for diagnosing these injuries is a computed tomography scan. Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation remains controversial. The available evidence regarding treatment options for these fractures is of low quality. Risk factors associated with the failure of nonoperative treatment are: comminution of the articular mass or facet joint, acute radiculopathy, high body mass index, listhesis exceeding 2 mm, fragmental diastasis, acute disc injury, and bilateral fractures or fractures that adversely affect 40% of the intact lateral mass height or have an absolute height of 1 cm.
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    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
    (2024) Cirillo, Ignacio; Ricciardi, Alejandro; Cabrera, Juan Pablo; López Muñoz, Felipe; Romero Vlverde, Lyanne; Joaquim, Andrei; Carazzo, Charles; Yurac, Ratko
    Study Design: systematic review.Objective: To evaluate risk factors associated with failure of non-operative management of isolated unilateral facet fractures ofthe subaxial cervical spine in neurologically intact patients.Methods: A systematic review of the PubMed, Embase, LILACS, and Cochrane Library databases was conducted in order todetermine risk factors associated with failure of non-operative management in isolated unilateral facet fractures of the subaxialcervical spine without facet and/or vertebral displacement, in neurologically intact patients. Our research was in line with thePRISMA 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 databaseswere included, along with 1 study found through a manual citation search. The evidence showed high clinical heterogeneity, aserious risk of bias according to the ROBINS-I tool, and a predominance of retrospective cohort studies. In comparison to lesscomplex facet fractures, lateral floating mass fractures were found to have 5.41 times higher odds of failure of non-operativemanagement (OR = 5.41; 95% CI = 1.32, 22.19). We calculated the potential association between lower absolute fracture heightand 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 dueto 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 termsor as a percentage) are significant risk factors for failure of non-operative treatment.

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