ArticleJournal of orthopaedic surgery and research2026
Radiographic subsidence after single-level anterior cervical discectomy and fusion; a comparison between blade-anchored zero-profile cages and stand-alone cages.
Article in Journal of orthopaedic surgery and research, 2026. 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
backgroundCage subsidence is a common radiographic finding after anterior cervical discectomy and fusion (ACDF), particularly with stand-alone cages, and may compromise postoperative alignment and stability. Blade-anchored zero-profile cages have been developed to provide immediate fixation while avoiding plate-related complications; however, their influence on subsidence characteristics has not been fully elucidated. This study aimed to compare the magnitude and direction of radiographic subsidence between blade-anchored zero-profile cages and stand-alone cages after single-level ACDF.
methodsThis retrospective single-center study included 76 patients who underwent single-level ACDF between 2017 and 2024 using either a blade-anchored zero-profile cage or a stand-alone cage. The anterior disc height (ADH) and posterior disc height (PDH) were measured preoperatively, immediately postoperatively, and at 6 months after surgery. The mean disc height was defined as the average of the ADH and PDH. Radiographic subsidence was calculated as the difference between the immediate postoperative and 6-month mean disc heights. Anterior and posterior subsidence were analyzed separately. Multivariable linear regression analyses were performed in two steps: Model 1 adjusted for demographic and baseline radiographic variables, and Model 2 further adjusted for disc height recovery to account for the effect of intraoperative disc height restoration.
resultsMean subsidence was significantly greater in the blade-anchored zero-profile cage group than in the stand-alone cage group, and the incidence of subsidence ≥ 3 mm was higher with blade-anchored cages. Directional analysis demonstrated significantly greater anterior subsidence in the blade-anchored group, whereas posterior subsidence did not differ between the groups. In the multivariate analysis, cage type was independently associated with subsidence in Model 1; however, this association was attenuated after adjustment for disc height recovery in Model 2.
conclusionsBlade-anchored zero-profile cages were associated with greater radiographic subsidence after single-level ACDF compared with stand-alone cages, primarily due to increased anterior subsidence. The attenuation of the cage-type effect after adjustment for disc height recovery suggests a potential role of restoration-related factors. Directional assessment of subsidence may provide additional insights into implant-specific behavior.
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