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Risk factors for polyetheretherketone cage subsidence following minimally invasive transforaminal lumbar interbody fusion

  • Original Article - Spine degenerative
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Abstract

Background

Interbody cage subsidence is a postoperative complication leading to poor outcomes after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). This study aimed to identify risk factors of cage subsidence in lumbar spinal diseases after MIS-TLIF using polyetheretherketone (PEEK) cage.

Methods

In this retrospective cohort study, plain radiographs and three-dimensional computed tomography (3D-CT) performed 12 months after MIS-TLIF were evaluated, and the risk of cage subsidence was calculated with odds ratio (OR), confidence interval (CI), and logistic regression analysis.

Results

A total of 114 patients (mean age, 65 years) and 135 levels were included in this study: 80 (59.3%) with and 55 (40.7%) without cage subsidence. Multifidus atrophy showed the strongest association with PEEK cage subsidence (p < 0.001). Compared to those with normal mass, the odds of PEEK cage subsidence were 76.0 (95% CI: 3.9–1472.9) for severe atrophy. The factors significantly associated with cage subsistence were posterior cage position (OR = 4.2; p = 0.005), cage height ≥ 12 mm (OR = 7.6; p = 0.008), use of an autograft mixed with demineralized bone matrix (DBM) (OR = 5.8; p = 0.002), body mass index (BMI) > 27.5 kg/m2 (OR = 4.2; p = 0.03), and titanium-coated PEEK (Ti-PEEK) cage-type (OR = 38.4, p = 0.02).

Conclusions

In MIS-TLIF with a PEEK cage, the factors associated with an increased risk of cage subsidence were higher BMI, increased severity of multifidus muscle atrophy, Ti-coated PEEK cage-type, cage height ≥ 12 mm, use of DBM mixed autograft, and posterior cage position.

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Acknowledgements

The authors thank Thanachaporn Kittipibul, MD, MS, and CU spine team for their support of this study.

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Authors and Affiliations

  1. Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand

    Weerasak Singhatanadgige, Amnat Sukthuayat, Teerachat Tanasansomboon & Worawat Limthongkul

  2. Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand

    Weerasak Singhatanadgige & Worawat Limthongkul

  3. Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand

    Terdpong Tanaviriyachai

  4. Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand

    Jatupon Kongtharvonskul

  5. Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Stephen J. Kerr

  6. The Kirby Institute, University of New South Wales, Sydney, Australia

    Stephen J. Kerr

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  1. Weerasak Singhatanadgige
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  2. Amnat Sukthuayat
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Correspondence to Worawat Limthongkul.

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Singhatanadgige, W., Sukthuayat, A., Tanaviriyachai, T. et al. Risk factors for polyetheretherketone cage subsidence following minimally invasive transforaminal lumbar interbody fusion. Acta Neurochir 163, 2557–2565 (2021). https://doi.org/10.1007/s00701-021-04923-y

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  • DOI: https://doi.org/10.1007/s00701-021-04923-y

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