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

Area of Science:

• Spinal surgery
• Orthopedic implants
• Biomaterials

Background:

• Cage subsidence is a known complication of anterior cervical discectomy and fusion (ACDF) surgery, with reported rates up to 40%.
• Different cage materials exhibit varying biomechanical properties, influencing subsidence rates.
• The novel Emerging Implant Technologies (EIT) titanium cage was introduced to address these concerns.

Purpose of the Study:

• To determine the subsidence rate of the EIT titanium cage after ACDF.
• To identify potential risk factors associated with EIT cage subsidence.
• To evaluate the impact of EIT cage subsidence on clinical and health-related quality of life (HRQOL) outcomes.

Main Methods:

• A retrospective cohort study of 39 patients (64 levels) who underwent ACDF with EIT cage insertion.
• Patients were monitored for cage subsidence (>3mm) and compared based on clinical outcomes and risk factors.
• HRQOL was assessed using validated instruments including VAS, EQ-5D-5L, EQ VAS, and NDI.

Main Results:

• Cage subsidence was observed in 23% of patients (16% of levels).
• Subsidence was not significantly associated with patient demographics (gender, age), smoking status, number of levels treated, or cage size.
• No significant impact of cage subsidence was found on VAS Neck, VAS Arms, EQ-5D-5L, EQ VAS, or NDI scores.

Conclusions:

• The EIT titanium cage appears to have a lower subsidence rate compared to other available cage types.
• Cage subsidence in this study did not correlate with identified risk factors or negatively affect patient HRQOL outcomes.