Subsidence Following Cervical Discectomy and Implant-to-bone Ratio.

Abstract Background Implant subsidence is an undesirable effect after anterior cervical discectomy and fusion (ACDF). We investigated the relation between the rate of implant subsidence and the ratio of the implant surface area to the surface area of the adjacent bone. Methods We analysed 170 disk spaces operated in a group of 104 patients. Two types of implants were used: 1) PEEK (polyetheretherketone) cages and 2) titanium-coated PEEK cages. Patients were randomised to receive a specific implant using a randomisation table. All implants had a surface area of 1.61 cm2. Based on CT images, bone surface areas were calculated for vertebral bodies immediately adjacent to the interbody implants. The implant-to-bone surface ratio was then calculated for each disk space. Implant subsidence was assessed over 12 months of follow-up, and associations between implant subsidence, the type of implant, and the implant-to-bone surface ratio were investigated. Results A total of 166 complete measurement data sets were available, capturing changes in intervertebral space and the presence of subsidence. 21% of intervertebral spaces demonstrated subsidence. Subsidence was more frequently associated with higher values of bone surface area and lower values of the implant-to-bone surface ratio. The type of implant (PEEK vs titanium-coated PEEK cages) did not significantly influence the rate of implant subsidence. Conclusions Implant subsidence was significantly related to the value of a coefficient representing the ratio of the implant's surface area to the bone surface area of the adjacent vertebral bodies, with subsidence occurring significantly more rarely for coefficient values ≥ 0.37.