Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Purpose: Cage subsidence is a common complication after anterior cervical discectomy and fusion (ACDF). However, the predictive accuracy of conventional Hounsfield units (HU) for subsidence varies across studies. We aimed to develop a simple, phantom-less calibrated method for measuring bone mineral density (BMD) using preoperative cervical computed tomography (CT) and compared its predictive efficacy for cage subsidence with HU values.
Methods: We retrospectively reviewed ACDF procedures performed by the corresponding author at our institution. Preoperative cervical spine CT scans were used to measure HU values at the surgical level. Additionally, HU values for calibration tissues-including cortical bone (CB), blood (B), skeletal muscle (SM), and adipose tissue (A)-were also measured. A linear regression equation was established from the HU measurements of these tissues and their standardized density values. The HU value at the surgical level was substituted into this equation to calculate volumetric BMD (vBMD). The area under the curve (AUC) was then calculated to compare the predictive efficacy of HU values and vBMD measurements for subsidence.
Results: Eighty-one patients were included in the study. Both HU values and calibrated vBMD were found to be risk factors for cage subsidence. Compared to HU values (AUC 0.703), calibrated vBMD (AUC 0.738-0.802) showed a stronger correlation with subsidence and higher predictive efficacy. Among the vBMD measurements, the combination of skeletal muscle and adipose (SM + A) provided the highest predictive efficacy (AUC 0.802), with an optimal cut-off value of 197.5 mg/cm³.
Conclusion: Both HU values and phantom-less calibrated vBMD are reliable predictors of cage subsidence after ACDF. The phantom-less calibrated vBMD can improve predictive efficacy for cage subsidence compared to HU values. We propose using SM + A calibrated vBMD to predict cage subsidence.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s00586-025-09284-z | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Subsidence reduction effect of transforaminal lumbar interbody fusion (TLIF) with upper and lower open windows modified with lattice structure.
Biomed Eng Lett
September 2025
Department of Mechanical Engineering, Sejong University, 209, Neungdong-Ro, Gwangjin-gu, Seoul, 05006 Republic of Korea.
Cage subsidence is a common complication following transforaminal lumbar interbody fusion (TLIF) that can lead to poor clinical outcomes, including recurrent pain and segmental instability. Conventional TLIF cage designs often fail to distribute stress evenly, increasing the risk of endplate damage and subsequent subsidence. This study aims to evaluate the effect of a modified TLIF cage with upper and lower open windows (lattice structure) in reducing cage subsidence in patients with lumbar degenerative disc disease (LDDD).
View Article and Find Full Text PDFExpandable Cage in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparative Data with Static Cage from Single Institution, Single Surgeon.
World Neurosurg
September 2025
Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. Electronic address:
Background: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is widely adopted for the treatment of lumbar degenerative disease. Expandable cages are now increasingly used in MIS-TLIF to facilitate disc height restoration in narrow spaces. Despite theoretical advantages, the clinical and radiologic outcomes of expandable cage compared to static cage remain controversial.
View Article and Find Full Text PDFComparative analysis of endplate volumetric bone mineral density and endplate vertebral bone quality for predicting cage subsidence in lateral lumbar interbody fusion.
J Neurosurg Spine
September 2025
1Clinical College of Orthopedics, Tianjin Medical University, Tianjin.
Objective: The aim of this study was to compare the predictive efficacy of quantitative CT (QCT)-based endplate volumetric bone mineral density (EP-vBMD) and MRI-based endplate vertebral bone quality (EBQ) score for cage subsidence (CS) after lateral lumbar interbody fusion (LLIF).
Methods: A retrospective study was conducted on patients who underwent single-level LLIF in conjunction with pedicle screw fixation at the authors' institution between January 2019 and April 2023. The volumetric bone mineral density (vBMD) was measured based on preoperative CT using phantom-less QCT software.
Expandable, But at What Cost? Failure Patterns in Corpectomy Cages from 373 Real-World Adverse Events.
Spine (Phila Pa 1976)
September 2025
Department of Neurosurgery, Donald and Barbara Zucker Hofstra School of Medicine at Northwell, Manhasset, NY, USA.
Study Design: Cross-sectional study.
Objective: This study aimed to analyze the failure patterns of expandable corpectomy cages.
Summary Of Background Data: Expandable corpectomy cages offer significant advantages for anterior column reconstruction but introduce unique mechanical complexities.
[Study on the effect of postoperative implant fusion after anterior cervical discectomy and fusion by applying nano-hydroxyapatite/collagen composite in patients with low bone mass cervical spondylosis].
Zhongguo Gu Shang
August 2025
Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing 100700, China.
Objective: To explore the effect of nano-hydroxyapatite/collagen composite (nHAC) on bone graft fusion after anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylosis and low bone mass.
Methods: A retrospective analysis was conducted on 47 patients with low bone mass who underwent ACDF from 2017 to 2021. They were divided into the nHAC group and the allogeneic bone group according to different bone graft materials.