Factors Influencing Interbody Cage Subsidence Following Anterior Cervical Discectomy and Fusion

Igarashi, Hidetoshi; Hoshino, Masahiro; Omori, Keisuke; Matsuzaki, Hiromi; Nemoto, Yasuhiro; Tsuruta, Takashi; Yamasaki, Koji

doi:10.1097/bsd.0000000000000843

Cited by 53 publications

(50 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Increased compressive forces is another basic mechanism which drive to endplate fracture and CS [24]. DH over-distraction is widely accepted as risk factor for CS in reports covering cervical fusion surgery [25]. In our study, we found that the increase in DH distraction was signi cantly correlated with CS following OLIF.…”

Section: Discussionsupporting

confidence: 54%

Clinical and Radiological Evaluation of Cage Subsidence Following Oblique Lumbar Interbody Fusion

Zhao¹,

Xie²,

Wang³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background Cage subsidence was previously reported as one of the most common complications following oblique lumbar interbody fusion (OLIF). We aimed to assess the impacts of CS on surgical results following OLIF, and determine its radiological characteristics and related risk factors. Methods Two hundred and forty-two patients underwent OLIF at L4-5 and with a minimum 12 months follow-up were reviewed. Patients were divided into three groups according to the extent disk height (DH) decrease during the follow-up: no CS (DH decrease ≤ 2 mm), mild CS (2mm < DH decrease ≤ 4 mm) and severe CS (DH decrease > 4mm). The clinical and radiological results were compared between groups to evaluate the radiological features, clinical effects and risk factors of CS. Results CS was identified in 79 (32.6%) patients, including 48 (19.8%) with mild CS and 31 (11.8%) with severe CS. CS mainly identified within 1 month postoperatively and did not progress after 3 months postoperatively, and more noted in the caudal endplate (44, 55.7%). In terms of clinical results, patients in the mild CS group were significantly worse than those in the no CS group, and patients in the severe CS group were significantly worse than those in the mild CS group. There was no significant difference in fusion rate between no CS (92.6%, 151/163) and mild CS (83.3%, 40/48) groups. However, significant lower fusion rate was observed in severe CS group (64.5%, 20/31) compared to no CS group. CS related risk factors included osteoporosis (OR = 5.976), DH overdistraction (OR = 1.175), flat disk space (OR = 3.309) and endplate injury (OR = 6.135). Conclusion CS following OLIF was an early postoperative complication. Higher magnitudes of CS were associated with worse clinical improvements and lower intervertebral fusion. Osteoporosis and endplate injury were significant risk factor for CS. Additionally, flat disk space and DH overdistraction were also correlated with the increased probability of CS.

show abstract

Section: Discussionsupporting

confidence: 54%

Clinical and Radiological Evaluation of Cage Subsidence Following Oblique Lumbar Interbody Fusion

Zhao¹,

Xie²,

Wang³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Early fusion can also reduce the frequency of follow-up imaging examinations and increase the confidence of spinal surgeons performing this surgical technique. At present, there are still a number of studies revealing that postoperative subsidence is related to poor clinical outcomes [28][29][30][31]. Igarashi et al [31] proposed that cage subsidence must be avoided in ACDF since it is often the cause of cervical foraminal stenosis and cage displacement.…”

Section: Discussionmentioning

confidence: 99%

“…At present, there are still a number of studies revealing that postoperative subsidence is related to poor clinical outcomes [28][29][30][31]. Igarashi et al [31] proposed that cage subsidence must be avoided in ACDF since it is often the cause of cervical foraminal stenosis and cage displacement.…”

Section: Discussionmentioning

confidence: 99%

Using a mixture of local bone dust and morselized bone as graft materials in single- and double-level ACDF

Liao

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Using a cage filled with local bone in anterior cervical discectomy and fusion (ACDF) can eliminate morbidities associated with autograft harvest from the iliac crest while achieving high fusion rates. However, there is still no consensus regarding the methods for using local bone grafts. This retrospective study was performed to compare the clinical and radiological outcomes of using a mixture of bone dust and morselized bone versus morselized bone alone in ACDF. Methods A retrospective study of 228 patients affected by cervical degenerative disease who had undergone single- or double-level ACDF between January 2014 and June 2018 was performed. Nanohydroxyapatite/polyamide-66 (n-HA/PA66) combined with morselized bone was used in 111 patients (group A: single-level ACDF in 51 patients and double-level ACDF in 60 patients), whereas the n-HA/PA66 cage combined with a mixture of bone dust and morselized bone was used in 117 patients (group B: single-level ACDF in 58 patients and double-level ACDF in 59 patients). The fusion rate, extent of cage subsidence, fusion segmental height (FSH), C2-7 lordosis, segmental sagittal alignment (SSA), 10-point visual analog scale (VAS) score, and Neck Disability Index (NDI) were compared between the two groups. Results The VAS score and NDI were significantly reduced after the operation in group A and group B. At the final follow-up, the fusion rate was 90.2 % (46/51) and 94.8 % (55/58) in patients treated with single-level ACDF in group A and group B, respectively (p > 0.05). In patients treated with double-level ACDF, bone fusion was achieved in 52 patients (86.7 %) in group A and 55 patients (93.2 %) in group B (p > 0.05). The fusion rate of single- and double-level ACDF was higher in patients in group B than those in group A at the 3-month, 6-month and 12-month follow-ups (p < 0.05). The extent of cage subsidence after single- and double-level ACDF was lower in patients in group B (1.5 ± 0.5 mm and 2.3 ± 0.8 mm, respectively) than in those in group A (1.8 ± 0.7 mm and 2.9 ± 1.4 mm, respectively) (p < 0.05). There was no significant difference between the two groups in the C2-7 lordosis, FSH, SSA, VAS score, or NDI before or after the operation (p > 0.05). Conclusions Using a mixture of local bone dust and morselized bone as cage-filling materials yielded comparably good clinical outcomes as using morselized bone alone in single- and double-level ACDF. However, the mixture graft of bone dust and morselized bone was more beneficial in promoting early fusion and reducing cage subsidence.

show abstract

“…Cage subsidence is a common complication following ACDF and can result in the loss of disc height, disrupting the sagittal alignment of the spine, preventing solid fusion, and introducing restenosis of the foramina (9,10). However, the impacts of cage subsidence on clinical outcomes remain controversial for the cervical spine (11). Several factors have been proposed to contribute to cage subsidence, including aggressive endplate preparation, osteoporosis, differences in treatment levels, cage size, and cage material (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Cage Subsidence in Anterior Cervical Decompression and Fusion: Zero Profile Anchored Spacer (ROI-C) vs. Conventional Cage and Plate Construct

et al. 2021

View full text Add to dashboard Cite

Background: Anterior cervical discectomy and fusion (ACDF) has been widely performed to treat cervical generative diseases. Cage subsidence is a complication after ACDF. Although it is known that segmental kyphosis, acceleration of adjacent segmental disease, and restenosis may occur due to cages subsidence; however detailed research comparing zero-profile cages (ROI-C) and conventional plate and cage construct (CPC) on cage subsidence has been lacking.Objective: The objectives of this study was to compare the rate of postoperative cage subsidence between zero profile anchored spacer (ROI-C) and conventional cage and plate construct (CPC) and investigate the risk factors associated with cage subsidence following ACDF.Methods: Seventy-four patients with ACDF who received either ROI-C or CPC treatment from October 2013 to August 2018 were included in this retrospective cohort study. Clinical and radiological outcomes and the incidence of cage subsidence at final follow up-were compared between groups. All patients were further categorized into the cage subsidence (CS) and non-cage subsidence (NCS) groups for subgroup analysis.Results: The overall subsidence rate was higher in the ROI-C group than in the CPC group (66.67 vs. 38.46%, P = 0.006). The incidence of cage subsidence was significantly different between groups for multiple-segment surgeries (75 vs. 34.6%, P = 0.003), but not for single-segment surgeries (54.55 vs. 42.30%, P = 0.563). Male sex, operation in multiple segments, using an ROI-C, and over-distraction increased the risk of subsidence. Clinical outcomes and fusion rates were not affected by cage subsidence.Conclusion: ROI-C use resulted in a higher subsidence rate than CPC use in multi-segment ACDF procedures. The male sex, the use of ROI-C, operation in multiple segments, and over-distraction were the most significant factors associated with an increase in the risk of cage subsidence.

show abstract

Factors Influencing Interbody Cage Subsidence Following Anterior Cervical Discectomy and Fusion

Cited by 53 publications

References 34 publications

Clinical and Radiological Evaluation of Cage Subsidence Following Oblique Lumbar Interbody Fusion

Clinical and Radiological Evaluation of Cage Subsidence Following Oblique Lumbar Interbody Fusion

Using a mixture of local bone dust and morselized bone as graft materials in single- and double-level ACDF

Comparative Analysis of Cage Subsidence in Anterior Cervical Decompression and Fusion: Zero Profile Anchored Spacer (ROI-C) vs. Conventional Cage and Plate Construct

Contact Info

Product

Resources

About