ArticleActa neurochirurgica2026
Risk of subsidence following ACDF with the coalition™ (Globus Medical) cage: a multivariable analysis identifying preoperative radiculopathy as the primary risk factor.
Article in Acta neurochirurgica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Coalition (Globus Medical) hybrid PEEK-titanium cage has been widely utilized in our practice for Anterior Cervical Discectomy and Fusion (ACDF) over a 5-year period. A preliminary review of all the cases that we performed in these five years show to us an unexpectedly high rate of postoperative cage subsidence with the Coalition (Globus Medical) stand-alone cage. This prompted a formal investigation, the purpose of this study was, therefore, to systematically determine the true rate of subsidence for the Coalition cage in our cohort and to identify the independent risk factors that could explain this finding.
methodsWe conducted a retrospective analysis of 70 consecutive patients who underwent ACDF with the Coalition cage between 2018 and 2023. Data on demographic, clinical, and surgical variables were collected. The primary outcome was cage subsidence (≥ 3 mm) assessed on lateral radiographs at a mean follow-up of 28.8 months (range 12-48). Independent predictors were identified through a multivariable logistic regression model constructed using the purposeful selection of covariates strategy, a multi-step iterative process that accounts for both statistical significance and confounding effects.
resultsThe overall patient-based subsidence rate was 38.6% (27 of 70 patients) at a mean radiographic follow-up of 28.8 months. Interrater reliability for subsidence assessment was substantial (Kappa = 0.759). In the multivariable analysis, preoperative diagnosis of radiculopathy was identified as the only independent predictor of subsidence, with an Adjusted Odds Ratio of 3.51 (95% CI: 1.13-10.91, p = 0.029). Contrary to initial assumptions, multi-level surgery (p = 0.441), smoking status (p = 0.615), and implant dimensions were not significant predictors in this cohort.
conclusionThe Coalition cage demonstrated a high rate of subsidence in this series. A preoperative diagnosis of radiculopathy was the primary independent risk factor for this outcome, rather than multi-level fusion or specific implant characteristics. These findings suggest that the biomechanical requirements of disc height restoration in patients with radiculopathy may predispose them to higher subsidence rates when utilizing this specific standalone integrated fixation device.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.