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Radiological Factors Affecting Cage Subsidence after Single-level Anterior Cervical Discectomy and Fusion with Double
Toshiyuki Okazaki1, Kazuma Doi1, Kazunori Shibamoto1
1Center for Minimally Invasive Spinal Surgery, Shin-Yurigaoka General Hospital.
Neurologia Medico-Chirurgica
|December 7, 2025
Summary
Central cage placement is crucial for preventing subsidence after anterior cervical discectomy and fusion. This common surgical method for degenerative cervical disease showed high subsidence rates, but central placement reduced risks.
Area of Science:
- Orthopedic Surgery
- Neurosurgery
- Radiology
Background:
- Anterior cervical discectomy and fusion (ACDF) is a standard treatment for degenerative cervical spine conditions.
- Cage subsidence is a known complication following ACDF, potentially impacting outcomes.
- Titanium cylindrical cages are commonly used in ACDF procedures.
Purpose of the Study:
- To investigate the relationship between radiological cage position and subsidence after ACDF.
- To identify radiological factors influencing subsidence in patients undergoing ACDF.
Main Methods:
- Retrospective analysis of 112 patients undergoing one-level ACDF for cervical myelopathy/radiculopathy.
- Subsidence defined as ≥3-mm decrease in segmental disc height at 1-year follow-up.
- Radiological cage position assessed on anterior-posterior and lateral X-rays.
Main Results:
- Subsidence occurred in 47.3% of patients (53 out of 112).
- Univariate analysis revealed that deviation of cages from the anatomical center on anterior-posterior view was significantly associated with subsidence.
- No patients required revision surgery due to subsidence at the 2-year minimum follow-up.
Conclusions:
- Central cage placement is critical for minimizing radiological subsidence after ACDF.
- While subsidence rates are high, clinical outcomes appear favorable without the need for revision surgery in this cohort.
- Further research may explore optimal cage positioning techniques to further reduce subsidence.
