Abstract
BackgroundTo clarify the risk factors for subsidence of titanium mesh cage (TMC) following single-level anterior cervical corpectomy and fusion (ACCF) to reduce subsidence.MethodsThe 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).ResultsSubsidence 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).ConclusionOur 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 anti-osteoporosis treatments 6 months prior to surgery might help surgeons to reduce subsidence after ACCF.
Highlights
To clarify the risk factors for subsidence of titanium mesh cage (TMC) following single-level anterior cervical corpectomy and fusion (ACCF) to reduce subsidence
A significant difference was observed between the loss of anterior and posterior intervertebral height in the subsidence group(p = 0.001), indicating that the loss of anterior intervertebral height was more significant than that of posterior intervertebral height
When the compression is extended to the vertebral body levels, anterior cervical corpectomy and fusion (ACCF) offers sufficient operating space and decompression extents [14]
Summary
To clarify the risk factors for subsidence of titanium mesh cage (TMC) following single-level anterior cervical corpectomy and fusion (ACCF) to reduce subsidence. Anterior cervical corpectomy and fusion (ACCF) has been a highly effective treatment for various pathologies including posterior osteophytes of vertebral, ossified posterior longitudinal ligament (OPLL), prolapse of free nucleus pulposus, and tumors. It has been shown to improve the long-term outcomes of patients as it sufficiently removes spinal cord compressions [1, 2]. Ji et al BMC Musculoskeletal Disorders (2020) 21:32 clinical outcomes [10]. Several reports indicate that age, sex, endplate preparation and level of corpectomy are associated with subsidence but there are no known definitive risk factors for this phenomenon. This study aimed to identify specific risk factors for TMC subsidence to facilitate better management of this condition
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