Subsidence of anchored cage after anterior cervical discectomy

Opšenák, René; Hanko, Martin; Snopko, Pavol; Varga, K; Kolarovszki, Branislav

doi:10.4149/bll_2019_058

Cited by 11 publications

(17 citation statements)

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“…Surgeons should be highly aware of the risk factors for subsidence to avoid its occurrence. Previously reported risk factors and those identified in the present study include and are not limited to age, sex, bone density, endplate preparation, cage material and position, over-distraction, and multi-segment fusion (22,(29)(30)(31).…”

Section: Discussionmentioning

confidence: 62%

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

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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.

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Section: Discussionmentioning

confidence: 62%

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

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“…5,[8][9][10] In addition, BMD is also one of the factors that can affect graft subsidence after ACDF. [4][5][6][7] To minimize selection bias, we only included single-level ACDF patients with plate fixation in this study. Patients with standalone devices, integrated screw or blade cage devices, or fusion without plating were all excluded.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Previous studies have reported that bone mineral density (BMD) is one of the factors that affects graft subsidence after ACDF. [4][5][6][7] Other factors affecting subsidence include age, cervical alignment, integrity of the endplate, use of plate fixation, number of treated levels, and properties of the interbody graft. 5,8-10 Thus, assessment of bone health in ACDF patients is an important part of the perioperative evaluation.Dual-energy x-ray absorptiometry (DEXA) is the most widely used way to assess BMD to diagnose osteopenia or osteoporosis.…”

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confidence: 99%

Lower Hounsfield units on CT are associated with cage subsidence after anterior cervical discectomy and fusion

Wang

Mummaneni

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEA consequence of anterior cervical discectomy and fusion (ACDF) is graft subsidence, potentially leading to kyphosis, nonunion, foraminal stenosis, and recurrent pain. Bone density, as measured in Hounsfield units (HUs) on CT, may be associated with subsidence. The authors evaluated the association between HUs and subsidence rates after ACDF.METHODSA retrospective study of patients treated with single-level ACDF at the University of California, San Francisco, from 2008 to 2017 was performed. HU values were measured according to previously published methods. Only patients with preoperative CT, minimum 1-year follow-up, and single-level ACDF were included. Patients with posterior surgery, tumor, infection, trauma, deformity, or osteoporosis treatment were excluded. Changes in segmental height were measured at 1-year follow-up compared with immediate postoperative radiographs. Subsidence was defined as segmental height loss of more than 2 mm.RESULTSA total of 91 patients met inclusion criteria. There was no significant difference in age or sex between the subsidence and nonsubsidence groups. Mean HU values in the subsidence group (320.8 ± 23.9, n = 8) were significantly lower than those of the nonsubsidence group (389.1 ± 53.7, n = 83, p < 0.01, t-test). There was a negative correlation between the HU values and segmental height loss (Pearson’s coefficient −0.735, p = 0.01). Using receiver operating characteristic curves, the area under the curve was 0.89, and the most appropriate threshold of HU value was 343.7 (sensitivity 77.1%, specificity 87.5%). A preoperative lower HU is a risk factor for postoperative subsidence (binary logistic regression, p < 0.05). The subsidence rate and distance between allograft and polyetheretherketone (PEEK) materials were not significantly different (PEEK 0.9 ± 0.7 mm, allograft 1.0 ± 0.7 mm; p > 0.05).CONCLUSIONSLower preoperative CT HU values are associated with cage subsidence in single-level ACDF. Preoperative measurement of HUs may be useful in predicting outcomes after ACDF.

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“…Son et al however refer a more significant global lordotisation after the implantation of the anchored cage in comparison to a cage fixed by the conventional plate 18 . CS had no significant impact on the clinical outcome after ACDF 19,20 . CS occurred most often in ventral portion of motion segment 19,20. In our study, CS in the ventral portion of motion segment had no significant impact on SSP in term of 24 months after ACDF.…”

Section: Discussionmentioning

confidence: 79%

Change in sagittal profile after implantation of anchored interbody cage in the surgical procedure for degenerative cervical spine disease

Opšenák¹,

Hanko²,

Snopko³

et al. 2021

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. The aim of this study was to verify the relationship between changes in the segmental sagittal profile (SSP) and changes in the global sagittal profile (GSP) after anterior cervical discectomy with anchored cage implantation (ACDF). Study design. Prospective study with 2-year follow-up. Methods. This study includes 104 patients after 1-level or 2-level ACDF operated between the May 2013 and March 2016. SSP was evaluated by Cobb angle measurement of operated motion segment (CobbS) and GSP was evaluated by Cobb angle measurement in C2-C7 segments (CobbG). Both SSP and GSP were measured pre-and postoperatively within a 24 months follow-up period. The influence of factors such as age, gender, number of treated segments and osteoporosis was evaluated using t-tests. The correlation between SSP and GSP changes was assessed by Pearson's correlation coefficient. Results. In the early postoperative period after 1-level ACDF, there was a significantly greater increase in CobbS compared to that of the 2-level ACDF (P=0.0149). Male patients experienced a significant decrease of CobbG during the first 6 months after surgery as well as patients with osteoporosis within 12 months after ACDF. After ACDF the SSP change weakly correlated with the GSP change. Conclusion. SSP change after 1-or 2-level ACDF correlates mostly weakly with GSP change. Male gender and osteoporosis were identified as risk factors for global lordotisation following ACDF.

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Subsidence of anchored cage after anterior cervical discectomy

Cited by 11 publications

References 0 publications

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

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

Lower Hounsfield units on CT are associated with cage subsidence after anterior cervical discectomy and fusion

Change in sagittal profile after implantation of anchored interbody cage in the surgical procedure for degenerative cervical spine disease

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