Safety of anterior cervical discectomy and fusion using titanium-coated polyetheretherketone stand-alone cages: Multicenter prospective study of incidence of cage subsidence

This multicenter prospective study investigated cage subsidence in anterior cervical discectomy and fusion (ACDF) using titanium-coated polyetheretherketone (PEEK) stand-alone cages. This study recruited patients who underwent 1- or 2-level ACDF using titanium-coated PEEK stand-alone cages for cervical disc disease. Patients with acute trauma or past cervical spine operations were excluded. Sixty-two cages in 42 patients were eligible for analysis. Minimum follow-up was 6 months after ACDF. Significant cage subsidence was recognized in 11 of 62 cages (17.7%). Cage subsidence was predominantly moderate (14.5%), with severe subsidence found in only 2 cages (3.2%). The slowest occurrence of cage subsidence was 6 months after surgery, in 4 of 11 cages. Frequency of cage subsidence did not differ significantly between patients <65 and ≥65 years old. Patients with and without cage subsidence both demonstrated significant improvement of neurological function. Cage subsidence resulted in aggravation of local angle, but finally did not affect C2-7 angle or cervical tilt angle. Severe cage subsidence was found in only 3.2% of patients within 6 months after ACDF. Cage subsidence aggravated local angle, but finally did not affect C2-7 angle or cervical tilt angle. One- or 2-level ACDF using titanium-coated PEEK stand-alone cages appears safe and justified, even in elderly patients.