Subsidence of Polyetheretherketone Cage after Anterior Cervical Fusion

Yong Min Kim; Kyu Won Oh; Dong Soo Kim; Eui Sung Choi; Hyun Chul Shon; Kyung Jin Park; Byung Ki Cho; Ji Kang Park; Ho Seung Jeong; Jung Wook Oh

doi:10.4055/jkoa.2014.49.3.185

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Kim, Oh, Kim, Choi, Shon, Park, Cho, Park, Jeong, and Oh: Subsidence of Polyetheretherketone Cage after Anterior Cervical Fusion

Original Article

Journal of the Korean Orthopaedic Association 2014; 49(3): 185-194.

Published online: 27 June 2014

DOI: https://doi.org/10.4055/jkoa.2014.49.3.185

Subsidence of Polyetheretherketone Cage after Anterior Cervical Fusion

Yong Min Kim, M.D., Kyu Won Oh, M.D., Dong Soo Kim, M.D., Eui Sung Choi, M.D., Hyun Chul Shon, M.D., Kyung Jin Park, M.D., Byung Ki Cho, M.D., Ji Kang Park, M.D., Ho Seung Jeong, M.D., Jung Wook Oh, M.D.

Department of Orthopedic Surgery, Chungbuk National University School of Medicine, Cheongju, Korea.

Correspondence to: Yong Min Kim, M.D. Department of Orthopedic Surgery, Chungbuk National University School of Medicine, 52 Naesudong-ro, Heungdeok-gu, Cheongju 361-763, Korea. TEL: +82-43-269-6077, FAX: +82-43-274-8719, ymkim@chungbuk.ac.kr

Received 13 October 2013 Revised 3 December 2013 Accepted 22 January 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to evaluate the rate and direction of subsidence that occurred after anterior cervical discectomy and fusion using the polyetheretherketone (PEEK) cage and to analyze the risk factors of subsidence.

Materials and Methods

Thirty two patients (36 segments) who underwent anterior cervical discectomy and fusion using the PEEK cage and autologous cancellous iliac bone graft from July 2003 to November 2011 were enrolled in this study. anterior segmental height (ASH), posterior segmental height (PSH) and cage corner distance (CCD) were measured on plain radiographs. Subsidence was defined as ≥2 mm decrease in the average of ASH and PSH at the final follow up compared to that measured in the immediate postoperative period. A decrease of more than 3 mm was defined as severe subsidence for further statistical analysis.

Results

Subsidence of more than 2 mm was observed in 14 segments (38.9%) and severe subsidence (≥3 mm) was observed in seven segments (19.4%). The direction of subsidence was examined by comparison of means of decreased ASH and PSH and anterior subsidence outweighed posterior subsidence (p<0.001). Examination of CCD showed that inferior subsidence was more frequent than superior subsidence (p<0.001, p=0.047). Among the suspicious risk factors for subsidence, intraoperative disc space distraction (anterior distraction: p=0.031, posterior distraction: p=0.007) and height of inserted cage (p=0.032) showed statistical significance.

Conclusion

Considerable incidence of subsidence was observed after use of the cage. Using a cage of appropriate height and prevention of intraoperative over-distraction of disc space will be helpful to prevention of subsidence of the cage after anterior cervical discectomy and fusion using the PEEK cage.

Keywords: anterior cervical fusion, subsidence, PEEK cage, segmental height

Figures and Tables

Figure 1

(A) Anterior segmental height (ASH) and posterior segmental height (PSH); (B) cage depth (CD, cage distance) and upper anterior cage corner distance (UACCD), upper posterior CCD (UPCCD), lower anterior CCD (LACCD), lower posterior CCD (LPCCD).

Figure 2

Segmental height variation in the non-subsidence group.

Figure 3

Segmental height variation in the subsidence group.

Table 1

Data Profiles of the Non-Subsidence Group

^*Level of segmental fusion. ^†Difference between preoperative and postoperative sagittal angle. ^‡Anterior distraction of disc space. ^§Posterior distraction of disc space.

Table 2

Data Profiles of the Subsidence Group

^*Level of segmental fusion. ^†Difference between preoperative and postoperative sagittal angle. ^‡Anterior distraction of disc space. ^§Posterior distraction of disc space.

Table 3

Variables Contained in Logistic Regression Equation of Subsidence over 2 mm

^*Changes of sagittal angle after operation. ^†Changes of anterior segmental height after operation. ^‡Changes of posterior segmental height after operation. ^§Diameter of the cage. ^∥Height of the cage.

Table 4

Bivariate Analysis of the Risk Factors of Subsidence over 2 mm

Table 5

Variables Contained in Logistic Regression Equation of Subsidence over 3 mm

Table 6

Bivariate Analysis of the Risk Factors of Subsidence over 3 mm

Notes

This work was supported by research grant of Chungbuk National University in 2013.

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