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Anterior location, sagittal malalignment and disc height loss below operated level increases cage subsidence - A review of 77 patients undergoing ACDF
EANS Academy. MacCormick A. 09/26/19; 275926; EP02060
Dr. Andrew MacCormick
Dr. Andrew MacCormick

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Abstract
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Purpose: For surgical management of degenerative cervical spine disease with myelo-radiculopathy, stand-alone cages are frequently used in one & two-level anterior cervical discectomy & fusion (ACDF) operations with a paucity of literature on factors influencing cage subsidence. The aim of this study was to analyse the variables affecting the incidence, location & severity of cage subsidence.
Methods: A retrospective review was performed of prospectively collected data of 77 patients (95 levels of surgery) undergoing ACDF. Variables analysed included age, gender, sagittal alignment, maximum disc height (superior, inferior & procedure level), cage size, shape, location, degree of subsidence (minor < 2mm, mild 2-5mm; moderate 5-7.5mm; severe >7.5mm) and location of subsidence. Results were then verified with a further senior study group member.
Results: The overall incidence of cage subsidence was 34% (32 levels) with 91% of these minor or mild. A significantly lower mean maximum height of the inferior disc was found in the subsidence group compared to the non-subsidence group (5.17 vs 5.96; p=0.0025). A significantly greater incidence of subsidence was recorded in patients with abnormal cervical spine alignment (focal or diffuse kyphosis) when compared with normal alignment (40% vs 18%, p=0.02). A greater incidence of subsidence was recorded with more anterior positioned cages (Anterior Vertebral Line - Anterior border of cage distance < 4mm) when compared to central or posterior cages (52%vs25%; p=0.01). No statistical significance was found for age, gender, superior disc height, cage shape/ size.
Conclusion: Greater incidence of cage subsidence is significantly associated with a lower maximum disc height of the disc below the operated level (< 5.5 mm), abnormal sagittal alignment and more anteriorly positioned cages. We found that vast majority of cage subsidence was focal, minor to mild without having any immediate or late clinical implications in terms of need for revision surgery.
Purpose: For surgical management of degenerative cervical spine disease with myelo-radiculopathy, stand-alone cages are frequently used in one & two-level anterior cervical discectomy & fusion (ACDF) operations with a paucity of literature on factors influencing cage subsidence. The aim of this study was to analyse the variables affecting the incidence, location & severity of cage subsidence.
Methods: A retrospective review was performed of prospectively collected data of 77 patients (95 levels of surgery) undergoing ACDF. Variables analysed included age, gender, sagittal alignment, maximum disc height (superior, inferior & procedure level), cage size, shape, location, degree of subsidence (minor < 2mm, mild 2-5mm; moderate 5-7.5mm; severe >7.5mm) and location of subsidence. Results were then verified with a further senior study group member.
Results: The overall incidence of cage subsidence was 34% (32 levels) with 91% of these minor or mild. A significantly lower mean maximum height of the inferior disc was found in the subsidence group compared to the non-subsidence group (5.17 vs 5.96; p=0.0025). A significantly greater incidence of subsidence was recorded in patients with abnormal cervical spine alignment (focal or diffuse kyphosis) when compared with normal alignment (40% vs 18%, p=0.02). A greater incidence of subsidence was recorded with more anterior positioned cages (Anterior Vertebral Line - Anterior border of cage distance < 4mm) when compared to central or posterior cages (52%vs25%; p=0.01). No statistical significance was found for age, gender, superior disc height, cage shape/ size.
Conclusion: Greater incidence of cage subsidence is significantly associated with a lower maximum disc height of the disc below the operated level (< 5.5 mm), abnormal sagittal alignment and more anteriorly positioned cages. We found that vast majority of cage subsidence was focal, minor to mild without having any immediate or late clinical implications in terms of need for revision surgery.
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