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Influence of cervical bone mineral density on cage subsidence in patients following stand-alone anterior cervical discectomy and fusion

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Abstract

Purpose

Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical degenerative diseases. However, cage subsidence remains a frequent problem. We therefore investigated if cage design and site-specific bone mineral density (BMD) contribute to the rate and direction of subsidence following ACDF.

Methods

Patients were prospectively included and received two different cages (groups 1 and 2) using minimization randomization. The degree and direction of cage subsidence were determined using plain radiographs. Neck pain intensity on the visual analogue scale (VAS), the neck disability index (NDI), and the patient satisfaction index were recorded up to 12 months after surgery.

Results

88 patients were analysed with a mean age of 53.7 ± 11.8 years. BMD values decreased in craniocaudal direction from 302.0 ± 62.2 to 235.5 ± 38.9 mg/cm3. Both groups showed significant height gain after the operation (both p < 0.001), followed by height loss at 3 months (both p < 0.05) and at 3–12 months after the operation (both p > 0.05). Both groups showed improvement of VAS neck pain intensity (both p < 0.05) and NDI (both p < 0.05). The direction of cage subsidence was similar, no correlations were found between cage subsidence and BMD or various clinical parameters.

Conclusions

Implant geometry of both cages and variations of the operative procedure promoted a relatively high degree of cage subsidence. Further studies are necessary to identify a relation of BMD and subsidence using optimized implant geometry and by controlling additional intraoperative variables.

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Authors and Affiliations

  1. Department of Neurosurgery, Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany

    Christopher Brenke, Kirsten Schmieder & Martin Barth

  2. Department of Neurosurgery, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany

    Martin Dostal

  3. Department of Neuroradiology, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany

    Johann Scharf

  4. Department of Medical Statistics, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany

    Christel Weiß

Authors
  1. Christopher Brenke
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  2. Martin Dostal
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  3. Johann Scharf
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  4. Christel Weiß
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  5. Kirsten Schmieder
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  6. Martin Barth
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Correspondence to Christopher Brenke.

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Brenke, C., Dostal, M., Scharf, J. et al. Influence of cervical bone mineral density on cage subsidence in patients following stand-alone anterior cervical discectomy and fusion. Eur Spine J 24, 2832–2840 (2015). https://doi.org/10.1007/s00586-014-3725-9

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  • DOI: https://doi.org/10.1007/s00586-014-3725-9

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