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



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.


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.


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).


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

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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).

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