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Plate Augmentation in The Prevention of 3D-Printed Tritanium Cage Subsidence Following Anterior Cervical Discectomy
Simon B Roberts1, Mohammed Madi2, Muhammed Iqbal3
1Scottish National Spinal Service, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh, Scotland.
Background:
Interbody cage subsidence following anterior cervical discectomy and fusion (ACDF) surgery can be associated with increased pain, segmental kyphosis, accelerated adjacent segment disease, and decreased rates of fusion. This study investigated the incidence of cage subsidence following the use of cages using Tritanium technology as cage-only (CO) or cage-plate (CP) constructs in patients undergoing ACDF.
Methods:
This was a retrospective multicentre cohort study. Data was collected from hospital records and radiographs. All patients undergoing ACDF for cervical myelopathy or radiculopathy were included. Patients were divided into two groups by ACDF construct: CO and CP groups. Outcome measures included postoperative cage subsidence, presence of fusion, and surgical complications. Cage subsidence was calculated as the decrease in intervertebral height. Statistical analysis was performed by Student's t-test for continuous data and Fisher's exact test for categorical data.
Results:
76 patients were included with mean age 56.5 years at surgery (SD: + 12; range: 2981), comprising a total of 94 ACDF procedures. Single-level ACDF was performed in 61 patients and multilevel ACDF was performed in 15 patients. CO construct was used in 13 ACDFs and CP construct used in 81 ACDFs. Mean radiological followup was 8.5 months (SD: 6.3; range: 3-24). Cage subsidence rate was greater in CO group compared to CP group (CO 54% (n=7), 95% CI: 29-77%; CP 19% (n=15), 95% CI 12-28% (x2 p=0.01)). There was no significant difference in fusion rates between CO and CP groups. One patient underwent revision surgery for cage subsidence. Age, indication for surgery, number of levels treated, cage size, cage lordosis, and progression to fusion were not significantly associated with cage subsidence.
Conclusion:
Incidence of cage subsidence was greater when Tritanium cages were used for ACDF surgery as cage-only constructs compared to cageplate constructs. Correlation of these results with patient-reported outcomes would be valuable.
Level Of Evidence:
III.
