Research Advances in Therapeutic Strategies for Subaxial Cervical A1-Type Fractures: Controversies Surrounding SLIC Score 4 and the Impact of Osteoporosis

目的：探讨下颈椎A1型骨折的治疗策略，分析SLIC评分4分患者的治疗争议及骨质疏松对治疗决策的影响。方法：通过系统综述国内外文献，整合AO分型与SLIC评分系统的临床价值，结合生物力学研究及临床病例数据，分析保守治疗与手术干预的适应症，并探讨骨质疏松对预后的作用机制。结果：下颈椎A1型骨折多推荐保守治疗，但SLIC评分4分(合并不完全脊髓损伤)患者治疗存在争议。尤其当此类患者合并骨质疏松时，可通过降低骨强度、加剧椎体塌陷及后凸畸形进展，显著影响保守治疗效果，可能需升级为手术干预(如ACDF)。目前缺乏针对SLIC评分4分合并骨质疏松患者的高质量证据，现有分型系统未充分纳入骨密度参数，生物力学稳定性评估存在局限。结论：SLIC评分4分的下颈椎A1型骨折需结合神经功能、骨密度及椎体形态综合决策，骨质疏松患者应强化抗骨松治疗并动态评估稳定性。未来需开展多中心研究明确手术指征，建立基于骨代谢评估的精准治疗体系。Objective: To investigate the treatment strategies for subaxial cervical A1-type fractures, analyze the treatment controversies in patients with a SLIC score of 4, and explore the impact of osteoporosis on treatment decision-making. Methods: A systematic literature review was conducted to synthesize the clinical utility of the AO Spine classification and SLIC scoring systems. Biomechanical studies and clinical case data were integrated to analyze indications for conservative management versus surgical intervention, with a focus on elucidating the mechanistic role of osteoporosis in prognosis. Results: Conservative treatment remains the primary recommendation for most A1-type fractures. However, significant controversy persists in managing patients with a SLIC score of 4 (associated with incomplete spinal cord injury), particularly when combined with osteoporosis. Osteoporosis exacerbates vertebral collapse and kyphotic progression through reduced bone strength, compromising conservative outcomes and necessitating potential escalation to surgical interventions such as anterior cervical discectomy and fusion (ACDF). Current evidence lacks high-quality studies targeting this subgroup, and existing classification systems inadequately incorporate bone mineral density parameters, limiting biomechanical stability assessments. Conclusions: Therapeutic decision-making for SLIC score 4 A1-type fractures requires a comprehensive evaluation of neurological status, bone density, and vertebral morphology. Osteoporotic patients warrant intensified anti-osteoporotic therapy and dynamic stability assessments. Future multicenter studies are imperative to refine surgical indications and establish a precision-based treatment framework incorporating bone metabolic profiling.