Does titanium cage subsidence affect clinical outcomes in ACDF surgery? A tertiary centre experience

Cage subsidence after anterior cervical discectomy and fusion (ACDF) surgery has been well documented with rates of up to 40%. Cages fill the void after cervical discectomy and promote fusion. These materials have different biomechanical profiles with differing rates of subsidence. This retrospective cohort study aimed to determine subsidence rates specifically associated with the novel Emerging Implant Technologies (EIT) titanium cage, identify risk factors associated with subsidence, and evaluate whether subsidence affects clinical outcomes.

ACDF with insertion of stand-alone EIT cage was performed in 39 patients (64 levels) between December 2016 and February 2019 with a median follow-up of 11 months. Patients were classified into two groups; subsidence and non-subsidence, and were compared in terms of the resultant clinical outcomes as well as presence of risk factors. Health-related quality of life (HRQOL) outcomes were assessed using Visual Analogue Scale (VAS) for neck and arm pain, EuroQol 5-Dimension 5-Level (EQ-5D-5L), EuroQol Visual Analogue Scale (EQ VAS) and Neck Disability Index (NDI) scores.

Cage subsidence (>3mm) was present in nine patients (23%), which corresponded to ten levels treated (16%). Development of subsidence was not associated with gender (p = 0.12), age (p = 0.27), smoking (p = 0.13), number of treatment levels (p = 0.10) or cage size used (p = 0.34). It had no effect on any of the HRQOL outcomes, namely VAS Neck (p = 0.07), VAS Arms (p = 0.08), EQ-5D-5L (p = 0.36), EQ VAS (p = 0.85) and NDI (p = 0.80).

The EIT cage seems to be associated with lower rates of subsidence compared with other cage types. Cage subsidence was not associated with HRQOL outcomes or risk factors.