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Updated: Aug 10, 2025
Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
Published on: July 25, 2025
A meta-analysis of risk factors for cage migration after lumbar fusion surgery
Yang Hou1, Haoyang Shi1, Hongyang Shi1
1Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China.
Objective:
Cage migration is a rare complication after lumbar fusion surgery, and it is also the cause of lumbar revision surgery. Previous studies have reported that many influencing factors can increase the incidence of cage migration. However, there still remains controversial. The current study was conducted to investigate the risk factors influencing incidence of cage migration.
Methods:
A systematic database search of PubMed, Embase, Web of Science, Cochrane Library and Clinical Trials was performed for relevant articles published until July 2022. According to the inclusion and exclusion criteria, two evaluators independently conducted literature screening, data extraction and quality evaluation of the obtained literature. The Newcastle-Ottawa Scale (NOS) score was used for quality evaluation, and meta-analysis was performed by STATA 16.0 software.
Results:
A total of 2126 relevant articles were initially identified, and 7 articles were finally included in this study for data extraction and meta-analysis. The results of meta-analysis showed that the bony endplate injury, pear-shaped disc, and screw loosening are significantly correlated with cage migration. The OR values (95%CI) of the three factors were 7.170 (3.015, 17.051), 8.056 (4.050, 16.023), and 12.840 (3.570, 46.177) respectively.
Conclusion:
Bony endplate injury, pear-shaped disc, and screw loosening are the current risk factors for cage migration postoperatively.
Insights
Cage migration after lumbar fusion surgery is a risk for revision surgery. Key risk factors identified include bony endplate injury, pear-shaped disc, and screw loosening, which are significantly correlated with this complication.
Area of Science:
- Spinal Surgery
- Orthopedics
- Neurosurgery
Background:
- Cage migration is a rare but significant complication following lumbar fusion surgery.
- It often necessitates revision surgery, highlighting the need to understand its contributing factors.
- Previous research has suggested various risk factors, but consensus remains elusive.
Purpose of the Study:
- To systematically investigate and identify definitive risk factors associated with cage migration after lumbar fusion.
- To provide evidence-based insights for preventing this complication.
Main Methods:
- A comprehensive systematic literature search was conducted across major databases (PubMed, Embase, Web of Science, Cochrane Library, Clinical Trials) up to July 2022.
- Literature screening, data extraction, and quality assessment (using Newcastle-Ottawa Scale) were performed independently by two evaluators.
- Meta-analysis was conducted using STATA 16.0 software to synthesize the findings.
Main Results:
- Seven studies, involving data from 2126 initially identified articles, were included in the final meta-analysis.
- The analysis revealed significant correlations between cage migration and bony endplate injury (OR=7.170), pear-shaped disc (OR=8.056), and screw loosening (OR=12.840).
Conclusions:
- Bony endplate injury, pear-shaped disc morphology, and screw loosening are identified as significant risk factors for postoperative cage migration.
- These findings are crucial for surgical planning and patient selection to mitigate the risk of cage migration and subsequent revision surgeries.
