ArticleBMC musculoskeletal disorders2025
Cage height is more important than surface area for preventing subsidence in multilevel anterior cervical discectomy and fusions.
Article in BMC musculoskeletal disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Single-level anterior cervical discectomy and fusion for degenerative disc disease: a retrospective, two-center comparative analysis of stand-alone cage versus cage-plate constructs.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
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9 authors.
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Abstract
backgroundThe relationships between subsidence and cage dimension and surface area in multilevel anterior cervical discectomy and fusion (ACDF) remain unclear in the current literature. This study aimed to analyze the risk factors influencing cage subsidence following multilevel ACDFs, and the relationship between cage subsidence and cage dimensions, surface area, patient-reported outcomes, and fusion rates.
methodsPatients who had undergone primary multilevel ACDFs with a minimum follow-up duration of 1 year were enrolled in this study. Cage subsidence was evaluated using lateral radiographs and defined as a decrease in disc height ≥3 mm. The patients were classified into the cage subsidence and no cage subsidence groups. Neck Disability Index (NDI) scores were recorded at baseline and every clinic visit. Fusion rates were evaluated at the final follow-up.
resultsEighty-five patients (mean age, 58.6 years; mean follow-up, 12.7 months) were included. The cage subsidence rates were 5%, 12%, 23%, and 31% at the 6-week, 3-month, 6-month, and 1-year follow-up, respectively. The demographic, perioperative, and radiographic parameters were not different between the two groups. Cage type, width, depth, and surface area did not influence the subsidence rates. Cage height was positively correlated with the depth of cage subsidence (p < 0.001, R = 0.263). A cage height ≥8 mm was associated with a higher risk of cage subsidence (odds ratio: 3.9, 95% confidence interval: 1.8–8.5, p < 0.001). An SPA ≥ 4° of the distal screw was identified as a risk factor for cage subsidence at the distal level. The overall fusion rate was 88.5% in both groups. NDI scores did not differ preoperatively or at follow-up.
conclusionsCage height and cage subsidence were significantly correlated in ACDF patients. A cage height ≥8 mm may be a risk factor for cage subsidence. A cage with a larger surface area may not provide protection against subsidence.
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