ArticleSpine surgery and related research2025
Impact of Cage Angle on Spinal Alignment in Posterior Lumbar Interbody Fusion: A Comparison of 12°, 16°, and 22° Cages.
Article in Spine surgery and related research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: We evaluated the effect of 3 high-angle cages on spinal alignment and clinical outcomes following posterior lumbar interbody fusion (PLIF). Methods: A retrospective analysis was performed on 104 patients who underwent PLIF at the L4/5 level between January 2021 and August 2023. Patients were divided into 3 groups: 12° (L), 16° (M), and 22° (H) cage groups. Lumbar spine radiographs were taken preoperatively and one year postoperatively to assess slip rate (% slip), segmental lumbar lordosis (SLL), segmental intervertebral angle (SIA), lumbar lordosis (LL), pelvic incidence-LL, sagittal vertical axis (SVA), Japanese Orthopedic Association score, and lower back pain visual analog scale score. Bone union and cage subsidence rates were evaluated using computed tomography 6 months postoperatively. Statistical analyses were performed using either the Wilcoxon signed rank test, Kruskal-Wallis test, or z-test. Results: Intragroup analysis showed significant improvements in local alignment, with notable SVA improvement in the H group. Intergroup comparisons revealed no significant differences in preoperative evaluation items. Postoperatively, the H group showed significantly greater improvements in SLL and SIA than the L group. Although no significant difference was observed in bone union, the cage subsidence rate was significantly higher in the H group than in other groups. Conclusions: PLIF using high-angle cages (≥12°) significantly improved local alignment in all groups. The 22° cage showed greater improvements in SLL and SIA but a higher incidence of cage subsidence. No significant clinical differences were observed between groups. LL in the lower lumbar spine can be achieved relatively easily using a cage with a larger angle in PLIF. However, although a cage with a larger angle may be advantageous for lordosis formation, postoperative clinical outcomes do not differ; therefore, cage selection should consider the surgeon's skill and patient factors, such as the degree of preoperative lumbar disc degeneration, instability, and alignment.
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