Erschienen in:
03.04.2023 | Originalien
Cage subsidence—A multifactorial matter!
verfasst von:
Periklis Godolias, MD, Zachary L. Tataryn, MD, Jonathan Plümer, MD, Charlotte Cibura, MD, Yevgeniy Freyvert, MD, Hansjörg Heep, MD, Marcel Dudda, MD, Thomas A. Schildhauer, MD, Jens R. Chapman, MD, Rod J. Oskouian, MD
Erschienen in:
Die Orthopädie
|
Ausgabe 8/2023
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Abstract
Study design
Retrospective cohort study
Objective
Wider cages are associated with improved decompression and reduced subsidence, but variation in cage physical properties limits consistent outcome analysis after thoracolumbar interbody fusion. This study investigated cage subsidence and its relationship to lateral and posterior approaches with a focus on the hypothesis that the larger surface area of lateral cages results in lower subsidence rates.
Methods
This study retrospectively reviewed 194 patients who underwent interbody fusion between 2016 and 2019 with a primary outcome of cage subsidence. Secondary outcomes were cage distribution (patients, approaches, expandability), cage dimensions, t‑scores, length of hospital stay, blood loss, surgical time, and pelvic incidence-lumbar lordosis (PI-LL) mismatch.
Results
Medical records were reviewed for 194 patients receiving 387 cages at 379 disc levels. Subsidence was identified in 35.1% of lateral cages, 40.9% of posterior cages, and 36.3% of all cages. Lower surface area (p = 0.008) and cage expandability were associated with subsidence risk. Lower anteroposterior cage length proved to be a significant factor in the subsidence of posteriorly placed cages (p = 0.007). Osteopenic and osteoporotic patients experienced cage subsidence 36.8% of the time compared to 3.5% of patients with normal t‑scores (p = 0.001). Cage subsidence correlated with postoperative deterioration of the PI-LL mismatch (p = 0.03). Patients receiving fusion augmentation with bone morphogenic protein experienced higher fusion rates (p < 0.01).
Conclusion
Cage subsidence is a common complication that can significantly impact operative outcomes following thoracolumbar interbody fusion. Low t‑scores, smaller surface area, cage expandability, and lower cage length in posterior approaches contribute significantly to cage subsidence.