Risk factors for subsidence of titanium mesh cage following single-level anterior cervical corpectomy and fusion

Abstract

Background: To clarify the risk factors for subsidence of titanium mesh cage (TMC) following single-level anterior cervical corpectomy and fusion (ACCF) to reduce subsidence. Methods: The present retrospective cohort study included 73 consecutive patients who underwent single-level ACCF. Patients were divided into subsidence (n = 31) and non-subsidence groups (n = 42). Medical records and radiological parameters such as age, sex, operation level, segmental angle (SA), cervical sagittal angle (CSA), height of anterior (HAE) and posterior endplate (HPE), ratio of anterior (RAE) and posterior endplate (RPE), the alignment of TMC, the global cervical Hounsfield Units (HU) were analyzed. Clinical results were evaluated using the Japanese Orthopedic Association (JOA) scoring system and the Visual Analog Scale (VAS). Results: Subsidence occurred in 31 of 73 (42.5%) patients. Comparison between the groups showed significant differences in the value of RAE, the alignment of TMC and the global cervical HU value (p < 0.001, p = 0.002, p < 0.001). In multivariate logistic regression analysis, RAE > 1.18 (OR = 6.116, 95%CI = 1.613-23.192, p = 0.008), alignment of TMC > 3°(OR = 5.355, 95%CI = 1.474-19.454, p = 0.011) and the global cervical HU value< 333 (OR = 11.238, 95%CI = 2.844-44.413, p = 0.001) were independently associated with subsidence. Linear regression analysis revealed that RAE is significantly positive related to the extent of subsidence (r = − 0.502, p = 0.006). Conclusion: Our findings suggest that the value of RAE more than 1.18, alignment of TMC and poor bone mineral density are the risk factors for subsidence. TMC subsidence does not negatively affect the clinical outcomes after operation. Avoiding over expansion of intervertebral height, optimizing placing of TMC and initiation of antiosteoporosis treatments 6 months prior to surgery might help surgeons to reduce subsidence after ACCF.

<p>Application of Titanium Alloy 3D-Printed Artificial Vertebral Body for Stage III Kümmell’s Disease Complicated by Neurological Deficits</p>

“…Cage subsidence occurred in 67.9% (19/28) and appeared before 6 months after the operation, while all patients achieved solid fusion at final follow-up, which is consistent with the results of previous studies. 37,47,48 Although internal fixation failure is common in cage subsidence with osteoporosis, it did not occur in our research. The outstanding result may be related to the use of a long segmental bone cement screw technique.…”

“… 28 , 36 The subsidence has been proven to correlate with osteoporosis, progressive resection of the endplate, a sharp edge of mesh, or over intervertebral distraction. 37–40 From June 2016, 12 consecutive patients with KD underwent anterior reconstruction with the 3D-AVB were involved in our center and compared with the previous 16 consecutive patients who restoration with the TMC. Our study showed that the subsidence was less with the group of 3DP-AVB than the TMC group (average, 0.97 mm vs 5.39 mm) and a lower risk of severe subsidence in the 3DP-AVB group (8.3% vs 50%, P <0.05).…”

“…Although the clinical consequence relevance of cage subsidence among the literature was quite different, 37 , 41 , 46 , 47 several studies proposed that loss of intervertebral height due to the subsidence could lead to buckling of the yellow ligament, foraminal stenosis, and eventually cause second nerve injury. 41 , 48 Different from previous researches, 48 the loss of height of the anterior border was much larger than that of the posterior because employment of posterior pedicle internal fixation system was to improve posterior column structural rigidity and prevent subsidence occurring at the posterior rim of the TMC, which leads to the great loss of kyphosis correction in our series.…”

Intravertebral cleft in pathological vertebral fracture resulting from spinal tuberculosis: a case report and literature review

“…According to reports, the incidence of implant-related complications is from 14.3 to 21.6% in anterior reconstruction surgery for Kümmell’s disease [ 26 ] and cage subsidence is an important risk factor related to the instrumentation failure [ 27 ]. In the past few years, 3D printed artificial vertebral body with good implant fit and less subsidence has gained traction in spine surgery [ 28 – 30 ] and the excellent result may attribute to the following aspects: (1) a larger diameter endcap of 3D prosthesis allows for an expansion of the bone-implant interface, which distributes point-loading and loads the periphery of the endplates where there is thicker cortical bone, and eventually reduces the risk of subsidence [ 29 , 31 ]; (2) with a Young‘s modulus more similar to native human bone (0.5–20 GPa), may reduce subsidence and ‘stress shadowing effect’ compared with traditional implants [ 32 ]; (3) the porosity of 3D vertebral body made by Ti6-Al4-V titanium alloy can enhance the delivery of osteoinductive factors as well as facilitate osteoconduction, thus potentially improving bony ingrowth [ 29 ].…”

A Novel Anatomic Titanium Mesh Cage for Reducing the Subsidence Rate After Anterior Cervical Corpectomy: A Finite Element Study

“…TMC subsidence may be correlated with poor clinical e cacy or poor neurological recovery. Severe subsidence will lead to symptom recurrence, deterioration of nerve function, failure of internal xation and kyphosis of the cervical spine [13,14]. There are many risk factors related to TMC subsidence, among which patients' own conditions and operation reasons can be avoided by case screening and operation technology improvements.…”