Factors influencing cage subsidence in anterior cervical corpectomy and discectomy: a systematic review

Dhar, Utpal Kanti; Menzer, Emma Lilly; Lin, Maohua; Hagerty, Vivian; O’Connor, Timothy E.; Tsai, Chi-Tay; Vrionis, Frank D.

doi:10.1007/s00586-023-07530-w

Cited by 16 publications

(13 citation statements)

References 70 publications

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“…Moreover, during follow-up, we observed a slight decrease in the C2-7 Cobb angle, which is consistent with previous reports [16]. The decrease in Cobb angle may be due to fusion cage sedimentation [1,17]. A previous study found that patients managed with stand-alone cages were more prone to sedimentation than those treated with a plate and cage combination, and a higher subsidence rate was detected in patients who underwent surgery at levels C5-C7 than at levels C2-C5 [17].…”

Section: Discussionsupporting

confidence: 92%

An adjustable and stable assistant-free anterior cervical retractor system for microscopy- assisted anterior cervical discectomy and fusion

Qian,

Lei,

et al. 2024

Preprint

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Background Anterior cervical discectomy and fusion (ACDF) is a standardized surgical strategy for treating cervical spondylopathy. This study aimed to introduce a newly developed retractor system and analyze its feasibility and safety in microscopy-assisted ACDF. Methods A newly developed retractor system was used in microscopy-assisted ACDF to treat patients with cervical spondylopathy. Demographic data and pre-, peri-, and postoperative clinical and imaging data were collected and analyzed retrospectively. Results A total of 48 patients were included in this study. Postoperative imaging data indicated sufficient decompression and good alignment. The Visual Analog Scale and Neck Disability Index score decreased preoperatively from 5.43 ± 1.12 and 29.77 ± 6.06 to 2.60 ± 0.78 and 11.75 ± 3.26 after surgery. The Japanese Orthopedic Association score increased preoperatively from 7.93 ± 1.37 to 12.22 ± 1.71 postoperatively. The C2–7 Cobb angles increased from 10.37 ± 6.79 to 14.58 ± 6.10 degrees after the procedure. No clinical or imaging-related complications were observed. Conclusion The newly developed retractor system showed good feasibility and safety for microscopy-assisted ACDF surgery, providing an option for clinical application.

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Section: Discussionsupporting

confidence: 92%

An adjustable and stable assistant-free anterior cervical retractor system for microscopy- assisted anterior cervical discectomy and fusion

Qian,

Lei,

et al. 2024

Preprint

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“…15 Therefore, efforts had been taken to investigate the etiology underlying postoperative subsidence in which multiple patient-oriented and procedure-related factors had been reported, including reduced bone mineral density, improper cage size and position, endplate violation, and so on. 16,17 Traditional LF Was Vulnerable to Postoperative Cage Subsidence It had been reported recently that the instruments played a vital role in the development of cage subsidence. Han et al 18 compared the incidence of cage subsidence in anterior cervical discectomy fusion (ACDF) with and without instrumentation and concluded the absence of instrumentation to be responsible for higher risk of cage subsidence.…”

Section: Discussionmentioning

confidence: 99%

“…However, as neurological decompression was achieved by adequately distracting interbody space with an oversized cage with excessive footprint, leading to enlarged foraminal area and increased disc height, the OLIF‐LF technique was incapable of direct circumferential neurological decompression as in the posterior approach, resulting in extreme reliance on the maintenance of distracted DH while decreased DH was reported to directly compromise initial decompression postoperatively and associated with radiculopathy recurrence 15 . Therefore, efforts had been taken to investigate the etiology underlying postoperative subsidence in which multiple patient‐oriented and procedure‐related factors had been reported, including reduced bone mineral density, improper cage size and position, endplate violation, and so on 16,17 …”

Section: Discussionmentioning

confidence: 99%

Reverse Lumbar Pedicle Screw in Oblique Lateral Interbody Fusion: A Novel Concept to Restrict Cage Subsidence

He,

Luo,

Fang

et al. 2023

Orthopaedic Surgery

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ObjectiveCage subsidence is a common morbidity after oblique lumbar interbody fusion (OLIF), with risk of compromising clinical and radiographic outcomes. The study aims to describe an innovative reverse lumbar pedicle screw (RLPS) technique in OLIF and compare its effect on restricting cage subsidence with classical lateral fixation (LF) in radiological and clinical evaluation.MethodConsecutive patients having undergone single‐level OLIF‐LF/RLPS from 2018 to 2020 were retrospectively reviewed. In OLIF‐RLPS, the upper entry point was determined at the intersection between one horizontal line (1 cm above inferior endplate) and one vertical line (dissecting anterior and middle thirds of the vertebra) while the inferior entry point between one horizontal line (5 mm below superior endplate) and the same vertical line. Trajectories were from vertebrae reverse into contralateral pedicle. Radiological evaluation included disc height (DH) and segmental lordosis (SL); cage subsidence was evaluated by DH loss. Clinical assessment included visual analogue scale (VAS) and Oswestry disability index (ODI). Student t or Mann–Whitney U test was used for continuous variation according to normality analysis while Chi‐square test for category variation.ResultsA total of 29 patients had been enrolled in the study including 14 cases in the RLPS group and 15 cases in the LF group. The DH in the OLIF‐RLPS group had increased from the preoperative 9.07 ± 1.73 mm to 13.73 ± 1.83 mm postoperatively, without significant difference compared with the OLIF‐LF group during the perioperative, but decreased to 12.53 ± 1.74 mm in 3 months and maintained at 12.00 ± 1.45 mm in 12 months, significantly higher than the OLIF‐LF group (p < 0.05). At the last follow‐up, 7.1% (1/14) cases in the OLIF‐RLPS group had shown subsidence of grade I, significantly less than 46.7% (7/15) cases in the OLIF‐LF group. Pain and disability had improved similarly in two groups, without significant difference detected between two groups at the last follow‐up.ConclusionRLPS technique with modified entry points and prolonged trajectory could effectively restrict cage subsidence in OLIF postoperatively compared with traditional lateral fixation.

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“…CS was defined as the sinking of the cage into the upper or lower endplate by more than 2 mm. 14 Baseline data including sex, age, body mass index (BMI), smoking status, duration of surgery, intraoperative blood loss, surgical level, osteoporosis, and timing of PNMCs were also collected.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, other aspects of the patients’ imaging data, such as cage subsidence (CS), unilateral/bilateral process decompression, the use of a cross-link, and the position of postoperative sclerotic MCs in the coronal and sagittal planes, were assessed. CS was defined as the sinking of the cage into the upper or lower endplate by more than 2 mm 14 . Baseline data including sex, age, body mass index (BMI), smoking status, duration of surgery, intraoperative blood loss, surgical level, osteoporosis, and timing of PNMCs were also collected.…”

Section: Methodsmentioning

confidence: 99%

Postoperative Sclerotic Modic Changes After Transforaminal Lumbar Interbody Fusion

Xiao,

Zhu,

Xiu

et al. 2023

Spine

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Study Design. A retrospective cohort study. Objective. This study aimed to assess postoperative sclerotic Modic changes (MCs) following transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative disc disease (LDD), investigating their prevalence, risk factors and association with clinical outcomes. Summary of Background Data. Sclerotic MCs may occur in patients with LDD after lumbar interbody fusion. The incidence and characteristics of postoperative sclerotic MCs, as well as their clinical impact, are unknown. Methods. The study included 467 patients (510 levels) who underwent single or two-level TLIF surgery, divided into a postoperative sclerotic MC group (60 patients, 66 levels) and non-MC group (407 patients, 444 levels). The time of development and location of postoperative sclerotic MCs, fusion rate, cage subsidence, bilateral process decompression, and cross-link usage were recorded. Preoperative, postoperative, and follow-up VAS and ODI scores were collected. Multivaraible logistic regression was used to evaluate factors associated with the development of postoperative sclerotic MCs. Results. The prevalence of postoperative sclerotic MCs was 12.8%. The postoperative sclerotic MC group had higher BMI. The postoperative sclerotic MC group demonstrated a fusion rate of 47%, significantly lower than that of the non-MC group (71%) at 6 months post-operation. At final follow-up, the fusion rate in the postoperative sclerotic MC group was 62%, significantly lower than that of the non-MC group (86%). Post-operative VAS and ODI scores were significantly higher in the group with postoperative sclerotic MCs. BMI and osteoporosis were significantly associated with the development of postoperative sclerotic MCs. Conclusion. Postoperative sclerotic MCs generally appear within the first year after surgery, with a prevalence of 12.8%. The presence of postoperative sclerotic MCs can adversely impact post-operative outcomes. To prevent postoperative sclerotic MCs, we postulate extending the immobilization period with external bracing and improving the management of BMI and osteoporosis in the peri-operative time window.

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Factors influencing cage subsidence in anterior cervical corpectomy and discectomy: a systematic review

Cited by 16 publications

References 70 publications

An adjustable and stable assistant-free anterior cervical retractor system for microscopy- assisted anterior cervical discectomy and fusion

An adjustable and stable assistant-free anterior cervical retractor system for microscopy- assisted anterior cervical discectomy and fusion

Reverse Lumbar Pedicle Screw in Oblique Lateral Interbody Fusion: A Novel Concept to Restrict Cage Subsidence

Postoperative Sclerotic Modic Changes After Transforaminal Lumbar Interbody Fusion

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