Artificial Vertebral Body Versus Titanium Mesh Cage for Single-Level Anterior Cervical Corpectomy and Fusion (ACCF): A Propensity Score Matching Analysis of Fusion, Implant Subsidence and Clinical Outcomes

Artificial Vertebral Body Versus Titanium Mesh Cage for Single-Level Anterior Cervical Corpectomy and Fusion (ACCF): A Propensity Score Matching Analysis of Fusion, Implant Subsidence and Clinical Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Artificial Vertebral Body Versus Titanium Mesh Cage for Single-Level Anterior Cervical Corpectomy and Fusion (ACCF): A Propensity Score Matching Analysis of Fusion, Implant Subsidence and Clinical Outcomes Haoxiang Wang, Ruomu Qu, Tian Xia, Hanbo Geng, Ziqi Yi, Yu Sun, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6940515/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Nov, 2025 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 14 You are reading this latest preprint version Abstract Background 3D printed artificial vertebral bodies (AVBs) have emerged as a viable alternative to traditional titanium mesh cages (TMCs) for spinal reconstruction following ACCF. However, existing comparative studies evaluating mid-term clinical and radiographic outcomes - particularly those incorporating quantitative assessments of fusion efficacy - remain inconclusive. This study aims to compare clinical and radiological outcomes between AVB and TMC in patients undergoing single-level ACCF with matched baseline characteristics. Methods Patients who underwent single-level ACCF for degenerative cervical myelopathy (DCM) between January 2012 and December 2022, with a minimum of 2-year clinical and radiological follow-up, were included. Patients were grouped by implant type (AVB or TMC), and propensity score matching (PSM) was used to balance baseline characteristics. Outcomes were assessed at 3 months and final follow-up (more than 2 years). Radiological assessments comprised: (1) fusion status evaluated via extra graft bridging bone (ExGBB) on computed tomography (CT) scans and interspinous motion (ISM) parameters; (2) implant subsidence; and (3) cervical alignment changes. Clinical parameters included neck pain (using Visual Analogue Scale), modified Japanese Association (mJOA) score and Neck Disability Index (NDI). Results A total of 93 patients were included (49 in AVB and 44 in TMC group). After 1:1 PSM, 36 patients were matched for each group, and intergroup comparisons revealed comparable baseline conditions. At 3 months, the AVB group exhibited significantly smaller ISM distance (p = 0.019) and less subsidence (p = 0.027) compared to the TMC group. The final follow-up duration was 3.57 ± 1.58 years. At final follow-up, no significant differences in subsidence and cervical alignment maintenance were observed. Furthermore, in fusion status, no significant intergroup differences were found, either in ExGBB or ISM criteria. The two group showed similar neurological recovery and pain alleviation, while the AVB group demonstrated significantly greater 3-month (p = 0.002) and final follow-up (p = 0.011) NDI improvement. However, no significant differences were observed in the proportion of patients achieving the minimal clinically important difference (MCID) for NDI. Conclusions The usage of AVB and TMC resulted in similar fusion outcomes, subsidence and neurological recovery at mid-term. However, AVB might have superior short-term implant stability with less 3-month subsidence and better fusion. anterior cervical corpectomy and fusion artificial vertebral body titanium mesh cage fusion neck disability index Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background ACCF is a widely utilized anterior surgical approach for treating cervical spine disorders, including degenerative conditions, tumors, and trauma [1,2]. Restoration of anterior column stability following corpectomy is critical to ensure procedural efficacy and safety. Common reconstruction options include autogenous bone grafts and TMC. Although TMCs have demonstrated effectiveness, they are associated with several limitations [3]. First, TMCs possess a relatively high elastic modulus and a small contact surface with the vertebral endplate [4], resulting in stress concentration and a correspondingly high rate of implant subsidence [5,6]. Additionally, the mismatch in elastic modulus between titanium and surrounding bone can lead to a stress-shielding effect [7–9], potentially inhibiting osteogenesis. The development of additive manufacturing has enabled three dimensional (3D)-printed titanium AVBs to emerge as a promising reconstruction option following ACCF [10,11]. The porous architecture of AVBs may theoretically enhance bone ingrowth by providing a more favorable microenvironment [12]. Additionally, AVBs exhibit an effective elastic modulus closer to autologous bone [13,14] and provide greater endplate-implant contact area, potentially reducing stress concentration and subsidence risk [10]. Comparative studies indicate AVBs demonstrate lower subsidence rates [10,15], better cervical lordosis restoration [10,11,15], and superior clinical outcomes versus TMCs [15]. However, conflicting evidence suggests that AVBs may not significantly reduce subsidence or improve cervical alignment compared to TMCs, while incurring substantially higher costs [16]. From our perspective, many of the existing studies included patients undergoing procedures at various spinal levels and lacked adequate control for potential confounding factors, which may have introduced baseline differences and compromised the validity of their conclusions. Additionally, previous studies have primarily focused on short-term subsidence outcomes within two years [10,15–17], and fusion has often been assessed using subjective criteria [15,17] or evaluation standards derived from anterior cervical discectomy and fusion (ACDF) [16]. Therefore, further research employing robust bias control methods, mid-term follow-up, and quantitative assessment of fusion status is warranted to better elucidate the clinical efficacy of AVBs. Therefore, this study included only patients who underwent single-level ACCF to minimize bias associated with varying numbers of surgical segments and utilized PSM to ensure comparable baseline conditions between groups. We believe that our study contributes to resolving existing controversies by incorporating comprehensive radiological parameters at multiple follow-up time points and employing more precise fusion assessment methods, including the ExGBB criteria on CT and the novel quantitative ISM criteria for ACCF on dynamic radiographs [18]. Our hypothesis is that the AVB group may demonstrate superior fusion outcomes and reduced subsidence compared to the TMC group. Methods Study design and participants This retrospective cohort study was approved by the institutional review board (IRB00006761-M2024132) and conducted in accordance with the Declaration of Helsinki. This study has been registered and approved by the Chinese Clinical Trial Registry (ChiCTR) with the registration number ChiCTR2400090700 (registration date 2024/10/11). Patients who underwent single-level ACCF for DCM at a single center between January 2012 and December 2022 were retrospectively reviewed. The inclusion criteria were: (1) age between 18 and 75 years; (2) availability of preoperative cervical spine X-ray and CT images; and (3) a minimum of 2 years of follow-up, including CT, neutral lateral and flexion-extension X-rays, and clinical assessments using patient-reported outcome measures (PROMs). The exclusion criteria were: (1) history of prior cervical spine surgery; (2) diagnosis of cervical spine tumor, fracture, or infection; and (3) concomitant ACDF or posterior procedures. A flowchart outlining the study design is presented in Figure 1. Surgical Procedure and Follow Up Exposure and localization of the index vertebral body were performed using standard surgical techniques. A distractor was placed at the superior and inferior ends of the affected vertebra to facilitate removal of the adjacent intervertebral discs. An ultrasonic osteotome was used to resect the majority of the target vertebral body down to the posterior cortical bone. A high-speed burr or ultrasonic osteotome was then carefully employed to remove a thin layer of cortical bone. In cases involving ossification of the posterior longitudinal ligament (OPLL), the ossified ligament was excised. The upper and lower endplates were meticulously shaped to be flat and parallel while preserving the bony endplates. The intervertebral space was distracted and measured to select an appropriately sized implant. The implant, packed with cancellous bone harvested during decompression, was inserted into the intervertebral space. After removing the distractor, fluoroscopy was used to confirm accurate implant placement. A suitable titanium plate was selected and securely fixed, with fluoroscopic verification to ensure proper positioning. Finally, a negative-pressure drain was inserted, and the wound was closed in layers. Patients were discharged following drain removal. Routine follow-ups were scheduled at 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively. Clinical outcomes measurements PROMs were assessed preoperatively, 3 months postoperatively, and at final follow-up for all patients. PROMs included neck pain (measured using the Visual Analogue Scale [VAS], ranging from 0 to 10), the mJOA score, and the NDI (ranging from 0 to 50). Changes in PROMs at 3 months and final follow-up were calculated relative to preoperative values. The mJOA recovery rate (mJOARR) was also calculated using the following formula: mJOARR = [(postoperative mJOA score – preoperative mJOA score) / (17 – preoperative mJOA score)]×100%. Based on prior studies, this study adopted established MCID thresholds and compared the proportion of patients in each group who achieved them. The MCID values were defined as 2.6 for VAS-neck [19,20], 1.25 for mJOA [21], 31.67% for mJOARR [21], and 6 points for NDI [20,22]. The incidence and causes of revision surgery were also recorded. Radiographic Measurements Radiographic data were obtained from the Picture Archiving and Communication System (PACS; General Electric Company, Boston, MA). The measurement methods are described below. 1) CT-Based Measurements (reviewed at the preoperative and final follow-up time points) (a) Fusion Status Assessment Postoperative bony fusion was evaluated using the presence of ExGBB in both sagittal and coronal planes [23-25]. ExGBB was graded as follows: ·Grade 0 (no fusion): No ExGBB in either sagittal or coronal view. ·Grade 1 (incomplete fusion): ExGBB observed in either plane without complete bridging between adjacent vertebrae. ·Grade 2 (complete fusion): Continuous bone bridging present in either sagittal or coronal view, without radiolucent lines at the graft–endplate interface [18,24] (Figure 2). In this study, Grade 2 was defined as bony fusion. (b) Adjacent Bone Quality Assessment Hounsfield unit (HU) values were measured at the central regions of the upper and lower vertebral bodies of the surgical segment, and the mean value was calculated [26-28] (Figure 3A). 2) X-Ray-Based Measurements (conducted at preoperative, immediate postoperative, 3-month postoperative, and final follow-up). (a) Sagittal Alignment Cervical sagittal parameters—including C2-7 sagittal vertical axis (SVA), C2-7 Cobb angle, C7 slope (C7S) and C2 slope (C2S)—were measured on neutral lateral X-rays (Figure 3B). (b) Interspinous Motion (ISM) ISM was used for quantitative fusion assessment based on lateral radiographs at 3 months and final follow-up. Parameters included ISM distance (ISM-dis) and ISM angle (ISM-ang) [29,30]. Fusion was defined as ISM-dis < 1.5 mm and ISM-ang < 1.75° under 150% image magnification, following the criteria by Wang et al [18] (Figure 4). (c) Subsidence Subsidence was evaluated at 3-month and final follow-up by measuring the reduction in segmental height (SH) compared to the immediate postoperative SH. SH loss≥3 mm was defined as subsidence [10,15,23] (Figure 5). Statistical Analysis Continuous variables were presented as mean±standard deviation. The Student’s t-test and Mann-Whitney U test were used to compare continuous variables between groups, while the Chi-square test was employed for categorical variables. PSM was applied to reduce confounding bias. Propensity scores were estimated using a logistic regression model that included age, follow-up duration, and the average HU value of the adjacent segment. The model yielded a C-statistic of 0.62, indicating fair discriminative ability. Patients in the AVB and TMC groups were matched based on the estimated propensity scores using a caliper width of less than 0.2. Results Patient Characteristics A total of 156 patients who underwent single-level ACCF using either AVB or TMC were initially included. Thirty-three patients were excluded due to diagnoses of cervical spine trauma, tumors, or infections. Among the remaining 123 patients, 49 in the AVB group and 44 in the TMC group had at least 2 years of follow-up data, forming the initial cohort. After PSM, 36 patients were matched in each group (Figure 1). The patient demographics are summarized in Table 1, and representative images of the two groups were shown in Figure 6-7. Baseline characteristics were comparable between the two groups. Table 1 Patient baseline clinical and surgical characteristics of both groups Before PSM After PSM AVB Group (n=49) TMC Group (n=44) P-value AVB Group (n=36) TMC Group (n=36) P-value Age 52.78±9.73 53.02±10.84 0.908 52.33±9.17 52.08±11.22 0.918 Gender (Female%) 23(46.94%) 27(61.36%) 0.164 18(50%) 21(58.33%) 0.478 BMI 25.35±2.91 24.42±3.77 0.200 24.79±2.75 24.72±3.79 0.936 Corpectomy Segment 0.509 0.559 C4 6(12.24%) 7(15.91%) 3(8.33%) 6(16.67%) C5 22(44.90%) 21(47.73%) 17(47.23%) 16(44.44%) C6 21(42.86%) 16(36.36%) 16(44.44%) 14(38.89%) Hypertension (%) 14(28.57%) 10(22.73%) 0.520 8(22.22%) 6(16.67%) 0.551 Diabetes (%) 8(16.33%) 4(9.09%) 0.299 6(16.67%) 3(8.33%) 0.478 Follow-up duration 3.46±1.15 4.57±2.47 0.060 3.34±1.20 3.81±1.90 0.438 Average HU value 327.28±70.41 347.79±93.72 0.235 337.80±68.45 338.00±80.84 0.991 Values are presented as number (%) or mean±standard deviation unless otherwise indicated. AVB, artificial vertebral body; TMC, titanium mesh cage; BMI, body mass index; HU, Hounsfield unit. CT Follow-up results The two groups showed similar fusion outcomes assessed by ExGBB at final follow-up (p=0.885), with both demonstrating a CT-based fusion rate (ExGBB Grade 2) of 61.11% (Table 2). Table 2 CT Fusion status of both groups on final follow-ups AVB Group (n=36) TMC Group (n=36) P-value ExGBB Grade 0.885 Grade 0 2(5.56%) 3(8.33%) Grade 1 12(33.33%) 11(30.56%) Grade 2 22(61.11%) 22(61.11%) Values are presented as number (%) or mean±standard deviation unless otherwise indicated. CT, computed tomography; AVB, artificial vertebral body; TMC, titanium mesh cage; ExGBB, extra graft bridging bone. X-Ray Follow-up results 1) Analysis of ISM at Different Time Points At 3 months postoperatively, the AVB group exhibited a significantly smaller ISM-dis compared to the TMC group (p = 0.019), while no significant difference was observed in ISM-ang (p = 0.242). However, by the final follow-up, no significant differences were found between the groups in either ISM-dis or ISM-ang. Similarly, no intergroup differences in fusion rates—assessed by ISM-dis or ISM-ang—were observed at either the three-month or final follow-up. 2) Analysis of Subsidence at Different Time Points At the 3-month follow-up, the AVB group demonstrated significantly less SH loss compared to the TMC group (p = 0.027), although the incidence of subsidence (SH loss ≥ 3 mm) did not differ significantly between the groups (p = 0.745). By the final follow-up, no significant differences were observed in either SH loss or subsidence rate (Table 3). Table 3 Comparisons of interspinous motion and implant subsidence of two groups AVB Group (n=36) TMC Group (n=36) P-value 3 months postoperatively ISM-dis 3.13±1.40 4.03±1.78 0.019* ISM-ang 3.33±1.69 3.82±1.83 0.242 Fusion based on ISM-dis 6(16.67%) 3(8.33%) 0.478 SH loss 1.68±1.40 2.08±0.97 0.028* Subsidence status 6(16.67%) 5(13.89%) 0.745 Final follow-up ISM-dis 2.16±2.13 1.49±1.27 0.330 ISM-ang 2.22±2.20 1.42±1.17 0.191 Fusion status based on ISM-dis 20(55.56%) 23(63.89%) 0.471 SH loss 2.21±1.45 2.33±1.05 0.496 Subsidence status 7(19.44%) 10(27.78%) 0.401 Values are presented as number (%) or mean±standard deviation unless otherwise indicated. AVB, artificial vertebral body; TMC, titanium mesh cage; ISM-dis, interspinous motion-distance; ISM-ang, interspinous motion-angle; SH, segmental height. *p＜0.05, statistically significant differences. 3)Analysis of Cervical Alignment Changes No significant intergroup differences were observed in sagittal parameter changes from the immediate postoperative period to the final follow-up. However, at the final follow-up, the TMC group exhibited a significantly higher SVA (p = 0.006) and a greater tendency toward increased C7S (p = 0.092) and C2S (p = 0.078) compared to the AVB group (Table 4). Table 4 Comparison of cervical alignment parameters of two groups AVB Group (n=36) TMC Group (n=36) P-value Preoperation C2-7 SVA 16.7±12.0 21.3±10.1 0.140 C2-7 Cobb 9.2±9.5 7.0±11.8 0.665 C2 Slope 7.0±8.3 10.3±9.4 0.347 C7 Slope 16.2±7.3 17.3±7.4 0.636 Immediate postoperative alignment C2-7 Cobb 9.2±9.5 7.0±11.8 0.180 C2-7 SVA 17.9±9.6 21.4±7.4 0.169 C2 Slope 7.1±8.6 6.5±9.4 0.673 C7 Slope 16.2±7.3 17.3±7.4 0.411 Final follow-up alignment change (immediate postoperation versus final follow up) C2-7 Cobb 11.0±7.9 10.5±10.7 0.844 △C2-7 Cobb -1.0±5.5 -3.4±9.0 0.151 C2-7 SVA 13.8±8.7 19.4±9.2 0.006* △C2-7 SVA -4.1±6.5 -1.9±8.3 0.241 C2 Slope 6.7±8.4 10.1±10.2 0.180 △C2 Slope -0.5±7.5 3.6±11.6 0.078 C7 Slope 17.6±5.5 20.6±7.1 0.411 △C7 Slope -1.5±5.6 0.2±7.1 0.092 Values are presented as number (%) or mean±standard deviation unless otherwise indicated. AVB, artificial vertebral body; TMC, titanium mesh cage; SVA, sagittal vertical axis. *p＜0.05, statistically significant differences. Clinical Outcomes The two groups exhibited comparable preoperative clinical conditions. At the 3-month postoperative follow-up, the AVB group reported significantly lower neck pain (p = 0.029) and NDI scores (p = 0.003) compared to the TMC group, with no significant difference in mJOA scores. Furthermore, the AVB group demonstrated significantly greater NDI improvement (p = 0.002). However, the proportion of patients achieving the MCID for NDI did not significantly differ between groups (AVB: 12/36; TMC: 7/36, p = 0.181). At the final follow-up, the AVB group continued to show significantly lower neck pain (p = 0.045) and NDI scores (p = 0.001) compared to the TMC group, with no significant difference in mJOA scores. The AVB group also demonstrated significantly greater improvement in NDI (p = 0.011). However, the proportion of patients achieving the MCID for NDI did not differ significantly between groups (AVB: 20/36; TMC: 13/36; p = 0.098) (Table 5). The TMC group exhibited a higher revision surgery rate at the final follow-up, although the difference was not statistically significant (p = 0.115). No patients in the AVB group required revision surgery. In contrast, four patients (11.11%) in the TMC group underwent revision procedures: two underwent C3-7 laminoplasty, one underwent C4-5 ACDF for postoperative adjacent segment disease (ASD), and one underwent C3-7 laminoplasty for recurrent myelopathic symptoms. No implant malposition or graft failure was observed in either group (Table 5). Table 5 Comparison of clinical outcomes of both groups AVB Group (n=36) TMC Group (n=36) P-value Preoperation Neck pain 3.00±2.79 3.11±2.62 0.787 mJOA 13.94±2.48 13.54±2.45 0.428 NDI 12.14±11.45 10.17±8.70 0.708 3 months postoperation Neck pain 2.56±1.89 3.64±2.20 0.029* Neck pain alleviation 0.44±2.72 -0.53±2.86 0.144 mJOA 15.86±1.11 15.03±1.82 0.115 mJOA improvement 1.92±2.09 1.49±1.83 0.329 mJOARR(%) 50.88±60.20 39.14±41.24 0.084 NDI 6.58±5.22 11.14±6.02 0.003* NDI improvement 5.56±10.35 -0.97±8.59 0.002* Final follow-up Duration of follow-up 3.34±1.20 3.81±1.90 0.438 Neck pain 1.65±2.20 2.75±2.80 0.045* Neck pain alleviation 1.34±3.51 0.44±3.80 0.299 mJOA 16.19±1.06 15.42±1.93 0.077 mJOA improvement 2.25±2.50 1.88±2.66 0.919 mJOARR (%) 57.84±64.18 40.98±77.94 0.186 NDI 3.36±5.48 8.47±7.95 0.001* NDI improvement 8.78±12.20 1.72±10.82 0.011* Revision surgery incidence (%) 0% 4(11.11%) 0.115 Values are presented as number (%) or mean±standard deviation unless otherwise indicated. AVB, artificial vertebral body; TMC, titanium mesh cage; VAS, Visual Analogue Scale; mJOA, modified Japanese Orthopedic Association; mJOARR, mJOA recovery rate; NDI, Neck Disability Index. *p＜0.05, statistically significant differences. Discussion 3D-printed AVBs have recently emerged as an innovative implant option for ACCF. While several studies suggest theoretical advantages of AVBs, including enhanced osseointegration potential and reduced postoperative subsidence risk [12,15,16,31,32], their clinical benefits remain controversial. Current clinical investigations of AVBs are limited by heterogeneous patient populations (varying surgical segments), short follow-up durations, lack of quantitative fusion assessments, and inadequate control for confounding variables. To address these limitations, we conducted this PSM study comparing mid-term clinical and radiological outcomes between AVB and traditional TMC implants in patients with well-matched baseline characteristics. We implemented multiple fusion assessment modalities, including the novel ISM criteria specifically developed for ACCF. To our knowledge, this represents the first PSM study evaluating mid-term AVB versus TMC outcomes and the first application of ISM fusion criteria in this context. Previous studies have reported inconsistent fusion rates for AVB, largely due to variations in assessment criteria. For instance, He et al. reported 100% fusion in the TMC group and 96.4% in the AVB group at a 2-year follow-up using an ISM criterion of < 1 mm [16]. However, this threshold, adapted from ACDF, may misestimate the fusion rate [30]. Cheng et al. assessed fusion based on an intervertebral angle change of less than 5° on dynamic radiographs [33], and the one-year fusion rates for AVB and TMC were 95.2% and 95.8%, respectively. Nevertheless, it is noteworthy that the cutoff value for angular change was originally established for ACDF [34]. Moreover, important baseline parameters such as age, follow-up duration, and HU values were not properly matched in these studies, which may significantly affect the comparison of fusion outcomes between groups. In our study, we included only patients who underwent single-level ACCF and used PSM to match patients with similar baseline characteristics to reduce confounding bias. After matching, 36 pairs of patients were identified. Fusion and subsidence were assessed at two time points—3 months postoperatively and at a minimum 2-year follow-up—using both a traditional semi-quantitative method (ExGBB) and a quantitative method specifically tailored for ACCF (ISM-dis and ISM-ang) [18,23,24]. Assessed via ExGBB on CT, the two groups showed comparable fusion outcomes at the final follow-up. Assessed by ISM [18], the AVB group demonstrated significantly lower ISM-dis at the 3-month follow-up, although no significant superiority was observed at the final follow-up. Consistent with the ISM-dis findings, the AVB group exhibited significantly less subsidence at the 3-month follow-up, suggesting that AVB implants may provide superior short-term stability. In conclusion, while requiring less bone graft material, the AVB group may achieve comparable mid-term fusion outcomes to TMC and demonstrate better short-term stability. This advantage may prove particularly significant in cases of substantial bone loss, such as those caused by tumors or infections. Several studies have investigated the clinical outcomes of AVB and TMC implants for ACCF; however, no consistent conclusions have been drawn. Li et al. reported that the AVB group exhibited lower neck pain at the 3-month follow-up and higher mJOA scores at both the 3-month and 2-year follow-ups, with no significant difference in NDI [15]. In contrast, He et al. found no significant differences in NDI or mJOA between groups at the 2-year follow-up [16]. In the present study, patients receiving AVBs showed statistically significant improvements in NDI scores at both 3-month and final follow-up assessments compared to the TMC group, while no significant differences in neurological recovery were observed. These discrepancies in clinical outcomes among studies may be attributed to differences in patient populations, follow-up durations, and baseline characteristic control. Furthermore, we suggest that the superior short-term implant stability observed in the AVB group may have contributed to improved neck function by reducing dysfunction associated with surgical segment instability [35,36]. Fang and Cheng et al. previously reported greater C2-7 Cobb angles in the AVB group at one-year follow-up compared to the TMC group [10,11]. In the present study, no significant intergroup differences in postoperative C2-7 Cobb angle, C2S, or C7S were observed at the final follow-up. However, the TMC group exhibited a greater SVA and a tendency toward larger increases in both C2S (p = 0.078) and C7S (p = 0.092) compared to the AVB group. As previous studies have demonstrated positive correlations between both C2S, C2-7 SVA and NDI [37–41], we suggest that the superior maintenance of sagittal balance in the AVB group may be consistent with the better NDI improvement mentioned above. However, no statistically significant intergroup differences were observed in the proportion of patients achieving the MCID for NDI (6 points, validated for the Chinese population) [22]. Consequently, larger-scale studies with extended follow-up periods are required to assess the long-term clinical efficacy of AVBs. Furthermore, considering the potentially higher costs associated with AVBs, rigorous cost-effectiveness analyses comparing AVBs with TMCs are warranted. This study has several limitations. First, it is a retrospective cohort study with a limited sample size, introducing unavoidable bias. Second, the follow-up duration was relatively short, potentially limiting the evaluation of long-term outcomes. Additionally, radiological outcomes were not assessed at more postoperative follow-up time points (e.g., 6 months, 1 year), restricting the ability to describe the detailed progression of fusion and subsidence. Future studies with larger sample sizes and extended follow-up periods are planned to further investigate the long-term radiological and clinical outcomes of AVB. Conclusions AVB and TMC may achieve comparable mid-term radiological and neurological outcomes in patients with similar baseline characteristics. Requiring less bone graft, AVB may provide superior early stability, evidenced by reduced ISM distances and subsidence. Abbreviations ACCF anterior cervical corpectomy and fusion AVB artificial vertebral body TMC titanium mesh cage DCM degenerative cervical myelopathy PSM propensity score matching ExGBB extra-graft bridging bone CT computed tomography ISM interspinous motion VAS Visual Analogue Scale mJOA Modified Japanese Orthopedic Association NDI Neck Disability Index ACDF anterior cervical discectomy and fusion 3D three dimensional PROM patient reported outcome measures OPLL ossification of posterior longitudinal ligament mJOARR Modified Japanese Orthopedic Association recovery rate MCID minimal clinically important difference PACS Picture Archiving and Communication System HU Hounsfield unit SVA sagittal vertical axis C7S C7 Slope C2S C2 Slope ROI region of interest ISM-dis interspinous motion-distance ISM-ang interspinous motion-angle SH segmental height BMI body mass index ASD adjacent segment disease Declarations Ethics approval and consent to participate This study was approved by the Ethics Review Board of Peking University Third Hospital (M2024132). The requirement for informed consent has been waived by the Ethics Review Board due to the retrospective nature of the study. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding The authors received no financial support for the research, authorship, and/or publication of this article. Authors' contributions HXW, RMQ, and TX were responsible for the study design, data collection and measurement, and manuscript writing. HBG, ZQY, YS, FSZ, SFP, XC, and YBZ assisted with data collection. ZJL and FFZ oversaw and reviewed the study design and manuscript writing. Acknowledgements This work was partially supported by National Key Research and Development Program of China (2021YFB3800800). 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Yaqoob K, Amjad I, Munir Awan MA, Liaqat U, Zahoor M, Kashif M. Novel Method for the Production of Titanium Foams to Reduce Stress Shielding in Implants. ACS Omega. 2023;8(2):1876-84. Fang T, Zhang M, Yan J, Zhao J, Pan W, Wang X, et al. Comparative Analysis of 3D-Printed Artificial Vertebral Body Versus Titanium Mesh Cage in Repairing Bone Defects Following Single-Level Anterior Cervical Corpectomy and Fusion. Med Sci Monit. 2021;27:e928022. Cheng H, Luo G, Xu D, Li Y, Wang Z, Yang H, et al. Comparison of radiological and clinical outcomes of 3D-printed artificial vertebral body with Titanium mesh cage in single-level anterior cervical corpectomy and fusion: A meta-analysis. Front Surg. 2022;9:1077551. Olivares-Navarrete R, Gittens RA, Schneider JM, Hyzy SL, Haithcock DA, Ullrich PF, et al. Osteoblasts exhibit a more differentiated phenotype and increased bone morphogenetic protein production on titanium alloy substrates than on poly-ether-ether-ketone. Spine J. 2012;12(3):265-72. Parthasarathy J, Starly B, Raman S, Christensen A. Mechanical evaluation of porous titanium (Ti6Al4V) structures with electron beam melting (EBM). J Mech Behav Biomed Mater. 2010;3(3):249-59. Taniguchi N, Fujibayashi S, Takemoto M, Sasaki K, Otsuki B, Nakamura T, et al. Effect of pore size on bone ingrowth into porous titanium implants fabricated by additive manufacturing: An in vivo experiment. Mater Sci Eng C Mater Biol Appl. 2016;59:690-701. Li J, Zhang J, Wang B, Huang K, Yang X, Song Y, et al. Comparison of Titanium Mesh Cage, Nano-Hydroxyapatite/Polyamide Cage, and Three-Dimensional-Printed Vertebral Body for Anterior Cervical Corpectomy and Fusion. Spine (Phila Pa 1976). 2025;50(2):88-95. He H, Fan L, Lü G, Li X, Li Y, Zhang O, et al. Myth or fact: 3D-printed off-the-shelf prosthesis is superior to titanium mesh cage in anterior cervical corpectomy and fusion? BMC Musculoskelet Disord. 2024;25(1):96. Wei F, Xu N, Li Z, Cai H, Zhou F, Yang J, et al. A prospective randomized cohort study on 3D-printed artificial vertebral body in single-level anterior cervical corpectomy for cervical spondylotic myelopathy. Ann Transl Med. 2020;8(17):1070. Wang H, Xia T, Qu R, Sun Y, Zhang F, Pan S, et al. Interspinous Motion Measurement Could Serve as a Quantitative Method for Assessing Bony Fusion after Anterior Cervical Corpectomy and Fusion (ACCF). Spine (Phila Pa 1976). 2024. Hartman TJ, Nie JW, MacGregor KR, Oyetayo OO, Zheng E, Singh K. Neck Disability Index as a Prognostic Factor for Outcomes Following Cervical Disc Replacement. Clin Spine Surg. 2023;36(8):310-6. Chung AS, Copay AG, Olmscheid N, Campbell D, Walker JB, Chutkan N. Minimum Clinically Important Difference: Current Trends in the Spine Literature. Spine (Phila Pa 1976). 2017;42(14):1096-105. Zhou F, Zhang Y, Sun Y, Zhang F, Pan S, Liu Z. Assessment of the minimum clinically important difference in neurological function and quality of life after surgery in cervical spondylotic myelopathy patients: a prospective cohort study. Eur Spine J. 2015;24(12):2918-23. Chien A, Lai DM, Cheng CH, Wang SF, Hsu WL, Wang JL. Responsiveness of the Chinese versions of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire and Neck Disability Index in postoperative patients with cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2015;40(17):1315-21. Lee DH, Park S, Hong CG, Park KB, Cho JH, Hwang CJ, et al. Fusion and subsidence rates of vertebral body sliding osteotomy: Comparison of 3 reconstructive techniques for multilevel cervical myelopathy. Spine J. 2021;21(7):1089-98. Lee DH, Park S, Lee CS, Hwang CJ, Cho JH, Cho ST. Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Myelopathy: Outcomes at Minimum Five years Follow-up. Spine (Phila Pa 1976). 2023;48(9):600-9. Lee J, Lee DH, Jung CW, Song KS. The Significance of Extra-Cage Bridging Bone via Radiographic Lumbar Interbody Fusion Criterion. Global Spine J. 2023;13(1):113-21. Mikula AL, Puffer RC, Jeor JDS, Bernatz JT, Fogelson JL, Larson AN, et al. Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes. J Neurosurg Spine. 2020;32(1):50-5. Pinter ZW, Reed R, Townsley SE, Mikula AL, Dittman L, Xiong A, et al. Titanium Cervical Cage Subsidence: Postoperative Computed Tomography Analysis Defining Incidence and Associated Risk Factors. Global Spine J. 2023;13(7):1703-15. Wang M, Mummaneni PV, Xi Z, Chang CC, Rivera J, Guinn J, et al. Lower Hounsfield units on CT are associated with cage subsidence after anterior cervical discectomy and fusion. J Neurosurg Spine. 2020;33(4):425-32. Balouch E, Burapachaisri A, Woo D, Norris Z, Segar A, Ayres EW, et al. Assessing Postoperative Pseudarthrosis in Anterior Cervical Discectomy and Fusion (ACDF) on Dynamic Radiographs Using Novel Angular Measurements. Spine (Phila Pa 1976). 2022;47(16):1151-6. Song KS, Piyaskulkaew C, Chuntarapas T, Buchowski JM, Kim HJ, Park MS, et al. Dynamic radiographic criteria for detecting pseudarthrosis following anterior cervical arthrodesis. J Bone Joint Surg Am. 2014;96(7):557-63. Burnard JL, Parr WCH, Choy WJ, Walsh WR, Mobbs RJ. 3D-printed spine surgery implants: a systematic review of the efficacy and clinical safety profile of patient-specific and off-the-shelf devices. Eur Spine J. 2020;29(6):1248-60. Choy WJ, Parr WCH, Phan K, Walsh WR, Mobbs RJ. 3-dimensional printing for anterior cervical surgery: a review. J Spine Surg. 2018;4(4):757-69. Cheng J, Chen J, Xie L, Feng S, Zhou J, Zhan F. [Treatment of cervical ossification of posterior longitudinal ligament with titanium alloy trabecular bone three-dimensional printed artificial vertebral body]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024;38(5):535-41. Kandziora F, Pflugmacher R, Scholz M, Schnake K, Putzier M, Khodadadyan-Klostermann C, et al. Treatment of traumatic cervical spine instability with interbody fusion cages: a prospective controlled study with a 2-year follow-up. Injury. 2005;36 Suppl 2:B27-35. Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. Open Orthop J. 2014;8:326-45. Zuckerman SL, Devin CJ. Pseudarthrosis of the Cervical Spine. Clin Spine Surg. 2022;35(3):97-106. Protopsaltis TS, Ramchandran S, Tishelman JC, Smith JS, Neuman BJ, Jr GMM, et al. The Importance of C2 Slope, a Singular Marker of Cervical Deformity, Correlates With Patient-reported Outcomes. Spine (Phila Pa 1976). 2020;45(3):184-92. Passfall L, Williamson TK, Krol O, Lebovic J, Imbo B, Joujon-Roche R, et al. Do the newly proposed realignment targets for C2 and T1 slope bridge the gap between radiographic and clinical success in corrective surgery for adult cervical deformity? J Neurosurg Spine. 2022;37(3):368-75. Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis. Spine (Phila Pa 1976). 2016;41(7):E396-402. Kim N, Suk KS, Kwon JW, Seo J, Ju H, Lee BH, et al. Clinical significance of the C2 slope after multilevel cervical spine fusion. J Neurosurg Spine. 2023;38(1):24-30. Divi SN, Bronson WH, Canseco JA, Chang M, Goyal DKC, Nicholson KJ, et al. How do C2 tilt and C2 slope correlate with patient reported outcomes in patients after anterior cervical discectomy and fusion? Spine J. 2021;21(4):578-85. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Nov, 2025 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Revision requested 07 Aug, 2025 Reviews received at journal 30 Jul, 2025 Reviews received at journal 21 Jul, 2025 Reviews received at journal 19 Jul, 2025 Reviewers agreed at journal 15 Jul, 2025 Reviews received at journal 13 Jul, 2025 Reviewers agreed at journal 13 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviewers agreed at journal 07 Jul, 2025 Reviewers invited by journal 07 Jul, 2025 Editor invited by journal 30 Jun, 2025 Editor assigned by journal 27 Jun, 2025 Submission checks completed at journal 27 Jun, 2025 First submitted to journal 20 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6940515","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":483203721,"identity":"76c8aa26-1533-4ca4-a2fa-247710d9e468","order_by":0,"name":"Haoxiang Wang","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Haoxiang","middleName":"","lastName":"Wang","suffix":""},{"id":483203723,"identity":"0d4d52cb-4493-4813-b199-83093fd4c901","order_by":1,"name":"Ruomu Qu","email":"","orcid":"","institution":"Peking University Third 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhongjun","middleName":"","lastName":"Liu","suffix":""},{"id":483203744,"identity":"15331706-199b-4cf8-bff0-d8f85e74c1f6","order_by":11,"name":"Feifei Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIie3RsWvCQBTH8RcOzuU06+8ImH8hoVAdCv1XTgJOHZyKQ7GBQKaCa6T9I+qi64VAXELnrFncRXAsjXUqhTPdOtwXbnnwgXs8IpvtP4b2zQkuMaad+DzRXUhFkDHj6k+EZEwi6Eb816SEno/h9sSpWaU0HNTKOc4MxHkrp9AVIJP+NlyndCNrxbzMQBgebr1DikVQ9DeySWnyXivOhIHwliD/BO4LsT+T56tEfJMYCJjgsv2YCq4RYBqNdQmg4KMw+0C4qprEMxE/i/JaPy3gLot98/J45w92UX40kR970eVMl/N0JjabzWb73Rc780eBTey07wAAAABJRU5ErkJggg==","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":true,"prefix":"","firstName":"Feifei","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2025-06-20 16:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6940515/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6940515/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-025-09308-1","type":"published","date":"2025-11-19T15:57:04+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86644983,"identity":"9fe9a9c6-422e-4460-891f-f5afc2891191","added_by":"auto","created_at":"2025-07-14 08:49:54","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":153686,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart of the study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6940515/v1/0d0df291502793c0a2dfdecf.jpeg"},{"id":86644984,"identity":"04fb5a30-4a62-421f-a866-e80a09818d65","added_by":"auto","created_at":"2025-07-14 08:49:54","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":146587,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eObservation of ExGBB on CT sagittal and coronal reconstructions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(A) A 68-year-old male who underwent C4 corpectomy with AVB reconstruction, achieving fusion 4.5 years postoperatively. (B) A 59-year-old male who underwent C5 corpectomy with AVB reconstruction, presenting with pseudarthrosis at 4.5 years postoperatively. (C) A 56-year-old male who underwent C5 corpectomy with TMC reconstruction, achieving fusion 10 years postoperatively. (D) A 62-year-old male who underwent C4 corpectomy with AVB reconstruction, presenting with pseudarthrosis at 3 years postoperatively.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6940515/v1/9cf85607dae5de7e696616ca.jpeg"},{"id":86644987,"identity":"c543b729-9389-4266-acb0-030f5820e45e","added_by":"auto","created_at":"2025-07-14 08:49:54","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":166290,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeasurement of HU values and cervical alignment parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(A) Measurement of HU values in vertebral bodies adjacent to the corpectomy segment on preoperative CT. An elliptical region of interest (ROI) was selected to maximize the inclusion of the vertebral body while excluding cortical bone and abnormal bone areas, such as venous channels. The mean HU value within the ROI was recorded. (B) Measurement of sagittal alignment parameters. The C2-7 sagittal vertical axis (SVA) was defined as the vertical distance from the posterior superior corner of C7 to a plumb line passing through the centroid of C2. The C2-7 Cobb angle was determined by drawing perpendicular lines to the inferior endplates of C2 and C7, with the angle formed between these lines recorded. The C2 Slope was measured as the angle between the extended line of the C2 inferior endplate and a horizontal reference line. The C7 Slope was measured as the angle between the extended line of the C7 superior endplate and a horizontal reference line.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6940515/v1/ed961fde2f58b06e2a8e8067.jpeg"},{"id":86646971,"identity":"734e0988-02e3-4286-b60f-983e68ace400","added_by":"auto","created_at":"2025-07-14 09:05:54","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":267887,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeasurement of interspinous motion (ISM)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA solid line was drawn to connect the calibration points of the upper and lower adjacent spinous processes of the corpectomy segment, and its length was measured in both extension (A) and flexion (B) views. The difference in length between these views was calculated as ISM-distance. Dotted lines were drawn to connect the midpoint of the screw heads (arrow) and the calibration point of the spinous processes. The angle formed between these two dotted lines was recorded, and the difference in angle between the extension and flexion views was calculated as ISM-angle.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6940515/v1/d80fc7659d732a8138ea72e2.jpeg"},{"id":86644989,"identity":"116f0f30-d9c9-4ae7-85da-c199c45be5ad","added_by":"auto","created_at":"2025-07-14 08:49:54","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":169898,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeasurement of implant subsidence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOn the neutral lateral view obtained immediately postoperatively (A) and at follow-up (B), the anterior and posterior fused segment height (SH) was measured (solid line), and the average SH was calculated. To account for potential magnification differences on X-ray, the anteroposterior diameter of C1 (dotted line) was also measured. Subsidence was defined as SH loss, calculated using the formula: SH loss = immediately postoperative SH - follow-up SH ×(immediately postoperative C1 anteroposterior diameter / follow-up C1 anteroposterior diameter).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6940515/v1/f98204606a2a4ae33ad02e31.jpeg"},{"id":86644993,"identity":"fdca2dc2-2070-4ff4-a471-cbe9a49da7c3","added_by":"auto","created_at":"2025-07-14 08:49:54","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":230024,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRepresentative images of a patient receiving AVB\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA 52-year-old male underwent C6 ACCF. (A) Preoperative neutral lateral radiograph; (B) Immediate postoperative radiograph; (C) Radiograph at 3 months postoperatively, showing an SH loss of 0.13 cm; (D) Radiograph at 5.5 years postoperatively, with an SH loss of 1.18 cm; (E) Preoperative MRI, with the arrow indicating spinal cord compression; (F) MRI at 5.5 years postoperatively; (G-H) Postoperative CT images in the coronal and sagittal planes, with arrows indicating the formation of ExGBB.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6940515/v1/5505b9595e2c0abbd623f0fc.jpeg"},{"id":86644995,"identity":"420c4392-00fc-4c8d-a81f-bbb195a8dd70","added_by":"auto","created_at":"2025-07-14 08:49:54","extension":"jpeg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":212346,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRepresentative images of a patient receiving TMC\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA 45-year-old female underwent C6 ACCF. (A) Preoperative neutral lateral radiograph; (B) Immediate postoperative radiograph; (C) Radiograph at 3 months postoperatively, showing an SH loss of 3.65 cm; (D) Radiograph at 5 years postoperatively, with an SH loss of 4.17 cm; (E) Preoperative MRI, with the arrow indicating spinal cord compression; (F) MRI at 5 years postoperatively; (G-H) Postoperative CT images in the coronal and sagittal planes, with arrows indicating the formation of ExGBB.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6940515/v1/5352e7c27993ae4f740db2c4.jpeg"},{"id":96649997,"identity":"daf46551-8fd7-4e1d-b863-4b28793d500a","added_by":"auto","created_at":"2025-11-24 16:04:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3836798,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6940515/v1/711ac12e-5ad6-452c-b71c-494002166a51.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Artificial Vertebral Body Versus Titanium Mesh Cage for Single-Level Anterior Cervical Corpectomy and Fusion (ACCF): A Propensity Score Matching Analysis of Fusion, Implant Subsidence and Clinical Outcomes","fulltext":[{"header":"Background","content":"\u003cp\u003eACCF is a widely utilized anterior surgical approach for treating cervical spine disorders, including degenerative conditions, tumors, and trauma [1,2]. Restoration of anterior column stability following corpectomy is critical to ensure procedural efficacy and safety. Common reconstruction options include autogenous bone grafts and TMC. Although TMCs have demonstrated effectiveness, they are associated with several limitations [3]. First, TMCs possess a relatively high elastic modulus and a small contact surface with the vertebral endplate [4], resulting in stress concentration and a correspondingly high rate of implant subsidence [5,6]. Additionally, the mismatch in elastic modulus between titanium and surrounding bone can lead to a stress-shielding effect [7\u0026ndash;9], potentially inhibiting osteogenesis.\u003c/p\u003e\u003cp\u003eThe development of additive manufacturing has enabled three dimensional (3D)-printed titanium AVBs to emerge as a promising reconstruction option following ACCF [10,11]. The porous architecture of AVBs may theoretically enhance bone ingrowth by providing a more favorable microenvironment [12]. Additionally, AVBs exhibit an effective elastic modulus closer to autologous bone [13,14] and provide greater endplate-implant contact area, potentially reducing stress concentration and subsidence risk [10]. Comparative studies indicate AVBs demonstrate lower subsidence rates [10,15], better cervical lordosis restoration [10,11,15], and superior clinical outcomes versus TMCs [15]. However, conflicting evidence suggests that AVBs may not significantly reduce subsidence or improve cervical alignment compared to TMCs, while incurring substantially higher costs [16].\u003c/p\u003e\u003cp\u003eFrom our perspective, many of the existing studies included patients undergoing procedures at various spinal levels and lacked adequate control for potential confounding factors, which may have introduced baseline differences and compromised the validity of their conclusions. Additionally, previous studies have primarily focused on short-term subsidence outcomes within two years [10,15\u0026ndash;17], and fusion has often been assessed using subjective criteria [15,17] or evaluation standards derived from anterior cervical discectomy and fusion (ACDF) [16]. Therefore, further research employing robust bias control methods, mid-term follow-up, and quantitative assessment of fusion status is warranted to better elucidate the clinical efficacy of AVBs.\u003c/p\u003e\u003cp\u003eTherefore, this study included only patients who underwent single-level ACCF to minimize bias associated with varying numbers of surgical segments and utilized PSM to ensure comparable baseline conditions between groups. We believe that our study contributes to resolving existing controversies by incorporating comprehensive radiological parameters at multiple follow-up time points and employing more precise fusion assessment methods, including the ExGBB criteria on CT and the novel quantitative ISM criteria for ACCF on dynamic radiographs [18]. Our hypothesis is that the AVB group may demonstrate superior fusion outcomes and reduced subsidence compared to the TMC group.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy design and participants\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cohort study was approved by the institutional review board (IRB00006761-M2024132) and conducted in accordance with the Declaration of Helsinki. This study has been registered and approved by the Chinese Clinical Trial Registry (ChiCTR) with the registration number ChiCTR2400090700 (registration date 2024/10/11). Patients who underwent single-level ACCF for DCM at a single center between January 2012 and December 2022 were retrospectively reviewed. The inclusion criteria were: (1) age between 18 and 75 years; (2) availability of preoperative cervical spine X-ray and CT images; and (3) a minimum of 2 years of follow-up, including CT, neutral lateral and flexion-extension X-rays, and clinical assessments using patient-reported outcome measures (PROMs). The exclusion criteria were: (1) history of prior cervical spine surgery; (2) diagnosis of cervical spine tumor, fracture, or infection; and (3) concomitant ACDF or posterior procedures. A flowchart outlining the study design is presented in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSurgical Procedure and Follow Up\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExposure and localization of the index vertebral body were performed using standard surgical techniques. A distractor was placed at the superior and inferior ends of the affected vertebra to facilitate removal of the adjacent intervertebral discs. An ultrasonic osteotome was used to resect the majority of the target vertebral body down to the posterior cortical bone. A high-speed burr or ultrasonic osteotome was then carefully employed to remove a thin layer of cortical bone. In cases involving ossification of the posterior longitudinal ligament (OPLL), the ossified ligament was excised. The upper and lower endplates were meticulously shaped to be flat and parallel while preserving the bony endplates. The intervertebral space was distracted and measured to select an appropriately sized implant. The implant, packed with cancellous bone harvested during decompression, was inserted into the intervertebral space. After removing the distractor, fluoroscopy was used to confirm accurate implant placement. A suitable titanium plate was selected and securely fixed, with fluoroscopic verification to ensure proper positioning. Finally, a negative-pressure drain was inserted, and the wound was closed in layers.\u003c/p\u003e\n\u003cp\u003ePatients were discharged following drain removal. Routine follow-ups were scheduled at 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical outcomes measurements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePROMs were assessed preoperatively, 3 months postoperatively, and at final follow-up for all patients. PROMs included neck pain (measured using the Visual Analogue Scale [VAS], ranging from 0 to 10), the mJOA score, and the NDI (ranging from 0 to 50). Changes in PROMs at 3 months and final follow-up were calculated relative to preoperative values. The mJOA recovery rate (mJOARR) was also calculated using the following formula:\u003c/p\u003e\n\u003cp\u003emJOARR = [(postoperative mJOA score \u0026ndash; preoperative mJOA score) / (17 \u0026ndash; preoperative mJOA score)]\u0026times;100%.\u003c/p\u003e\n\u003cp\u003eBased on prior studies, this study adopted established MCID thresholds and compared the proportion of patients in each group who achieved them. The MCID values were defined as 2.6 for VAS-neck [19,20], 1.25 for mJOA [21], 31.67% for mJOARR [21], and 6 points for NDI [20,22]. The incidence and causes of revision surgery were also recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRadiographic Measurements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRadiographic data were obtained from the Picture Archiving and Communication System (PACS; General Electric Company, Boston, MA). The measurement methods are described below.\u003c/p\u003e\n\u003cp\u003e1) CT-Based Measurements (reviewed at the preoperative and final follow-up time points)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(a) Fusion Status Assessment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePostoperative bony fusion was evaluated using the presence of ExGBB in both sagittal and coronal planes [23-25]. ExGBB was graded as follows:\u003c/p\u003e\n\u003cp\u003e\u0026middot;Grade 0 (no fusion): No ExGBB in either sagittal or coronal view.\u003c/p\u003e\n\u003cp\u003e\u0026middot;Grade 1 (incomplete fusion): ExGBB observed in either plane without complete bridging between adjacent vertebrae.\u003c/p\u003e\n\u003cp\u003e\u0026middot;Grade 2 (complete fusion): Continuous bone bridging present in either sagittal or coronal view, without radiolucent lines at the graft\u0026ndash;endplate interface [18,24]\u003csup\u003e\u0026nbsp;\u003c/sup\u003e(Figure 2).\u003c/p\u003e\n\u003cp\u003eIn this study, Grade 2 was defined as bony fusion.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(b) Adjacent Bone Quality Assessment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHounsfield unit (HU) values were measured at the central regions of the upper and lower vertebral bodies of the surgical segment, and the mean value was calculated [26-28]\u003csup\u003e\u0026nbsp;\u003c/sup\u003e(Figure 3A).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2) X-Ray-Based Measurements (conducted at preoperative, immediate postoperative, 3-month postoperative, and final follow-up).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(a) Sagittal Alignment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCervical sagittal parameters\u0026mdash;including C2-7 sagittal vertical axis (SVA), C2-7 Cobb angle, C7 slope (C7S) and C2 slope (C2S)\u0026mdash;were measured on neutral lateral X-rays (Figure 3B).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(b) Interspinous Motion (ISM)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eISM was used for quantitative fusion assessment based on lateral radiographs at 3 months and final follow-up. Parameters included ISM distance (ISM-dis) and ISM angle (ISM-ang) [29,30]. Fusion was defined as ISM-dis \u0026lt; 1.5 mm and ISM-ang \u0026lt; 1.75\u0026deg; under 150% image magnification, following the criteria by Wang et al [18]\u003csup\u003e\u0026nbsp;\u003c/sup\u003e(Figure 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(c) Subsidence\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSubsidence was evaluated at 3-month and final follow-up by measuring the reduction in segmental height (SH) compared to the immediate postoperative SH. SH loss\u0026ge;3 mm was defined as subsidence [10,15,23]\u003csup\u003e\u0026nbsp;\u003c/sup\u003e(Figure 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContinuous variables were presented as mean\u0026plusmn;standard deviation. The Student\u0026rsquo;s t-test and Mann-Whitney U test were used to compare continuous variables between groups, while the Chi-square test was employed for categorical variables. PSM was applied to reduce confounding bias. Propensity scores were estimated using a logistic regression model that included age, follow-up duration, and the average HU value of the adjacent segment. The model yielded a C-statistic of 0.62, indicating fair discriminative ability. Patients in the AVB and TMC groups were matched based on the estimated propensity scores using a caliper width of less than 0.2.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePatient Characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 156 patients who underwent single-level ACCF using either AVB or TMC were initially included. Thirty-three patients were excluded due to diagnoses of cervical spine trauma, tumors, or infections. Among the remaining 123 patients, 49 in the AVB group and 44 in the TMC group had at least 2 years of follow-up data, forming the initial cohort. After PSM, 36 patients were matched in each group (Figure 1). The patient demographics are summarized in Table 1, and representative images of the two groups were shown in Figure 6-7. Baseline characteristics were comparable between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Patient baseline clinical and surgical characteristics of both groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eAVB Group (n=49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eTMC Group (n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eAVB Group (n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003eTMC Group (n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e52.78\u0026plusmn;9.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e53.02\u0026plusmn;10.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.908\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e52.33\u0026plusmn;9.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e52.08\u0026plusmn;11.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.918\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eGender (Female%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e23(46.94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e27(61.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.164\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e18(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e21(58.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.478\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e25.35\u0026plusmn;2.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e24.42\u0026plusmn;3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.200\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e24.79\u0026plusmn;2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e24.72\u0026plusmn;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.936\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eCorpectomy Segment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.509\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.559\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eC4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e6(12.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e7(15.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3(8.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e6(16.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eC5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e22(44.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e21(47.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e17(47.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e16(44.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eC6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e21(42.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e16(36.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e16(44.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e14(38.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eHypertension (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e14(28.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e10(22.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.520\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e8(22.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e6(16.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.551\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDiabetes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e8(16.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4(9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.299\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e6(16.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e3(8.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.478\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eFollow-up duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3.46\u0026plusmn;1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.57\u0026plusmn;2.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.060\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3.34\u0026plusmn;1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e3.81\u0026plusmn;1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.438\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eAverage HU value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e327.28\u0026plusmn;70.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e347.79\u0026plusmn;93.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.235\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e337.80\u0026plusmn;68.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e338.00\u0026plusmn;80.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.991\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are presented as number (%) or mean\u0026plusmn;standard deviation unless otherwise indicated.\u003c/p\u003e\n\u003cp\u003eAVB, artificial vertebral body; TMC, titanium mesh cage; BMI, body mass index; HU, Hounsfield unit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCT Follow-up results\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe two groups showed similar fusion outcomes assessed by ExGBB at final follow-up (p=0.885), with both demonstrating a CT-based fusion rate (ExGBB Grade 2) of 61.11% (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 CT Fusion status of both groups on final follow-ups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003eAVB Group (n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 143px;\"\u003e\n \u003cp\u003eTMC Group (n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eExGBB Grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.885\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eGrade 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e2(5.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e3(8.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eGrade 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e12(33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e11(30.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eGrade 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e22(61.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 143px;\"\u003e\n \u003cp\u003e22(61.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 141px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are presented as number (%) or mean\u0026plusmn;standard deviation unless otherwise indicated.\u003c/p\u003e\n\u003cp\u003eCT, computed tomography; AVB, artificial vertebral body; TMC, titanium mesh cage; ExGBB, extra graft bridging bone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eX-Ray Follow-up results\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e1) Analysis of ISM at Different Time Points\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAt 3 months postoperatively, the AVB group exhibited a significantly smaller ISM-dis compared to the TMC group (p = 0.019), while no significant difference was observed in ISM-ang (p = 0.242). However, by the final follow-up, no significant differences were found between the groups in either ISM-dis or ISM-ang. Similarly, no intergroup differences in fusion rates\u0026mdash;assessed by ISM-dis or ISM-ang\u0026mdash;were observed at either the three-month or final follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2) Analysis of Subsidence at Different Time Points\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAt the 3-month follow-up, the AVB group demonstrated significantly less SH loss compared to the TMC group (p = 0.027), although the incidence of subsidence (SH loss \u0026ge; 3 mm) did not differ significantly between the groups (p = 0.745). By the final follow-up, no significant differences were observed in either SH loss or subsidence rate (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Comparisons of interspinous motion and implant subsidence of two groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eAVB Group (n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eTMC Group (n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 617px;\"\u003e\n \u003cp\u003e\u003cem\u003e3 months postoperatively\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eISM-dis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.13\u0026plusmn;1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e4.03\u0026plusmn;1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.019*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eISM-ang\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.33\u0026plusmn;1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.82\u0026plusmn;1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.242\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eFusion based on ISM-dis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e6(16.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3(8.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.478\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eSH loss\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.68\u0026plusmn;1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2.08\u0026plusmn;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.028*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eSubsidence status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e6(16.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e5(13.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 617px;\"\u003e\n \u003cp\u003e\u003cem\u003eFinal follow-up\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eISM-dis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2.16\u0026plusmn;2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.49\u0026plusmn;1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.330\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eISM-ang\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2.22\u0026plusmn;2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.42\u0026plusmn;1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eFusion status based on ISM-dis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e20(55.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e23(63.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eSH loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2.21\u0026plusmn;1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2.33\u0026plusmn;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eSubsidence status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e7(19.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e10(27.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are presented as number (%) or mean\u0026plusmn;standard deviation unless otherwise indicated.\u003c/p\u003e\n\u003cp\u003eAVB, artificial vertebral body; TMC, titanium mesh cage; ISM-dis, interspinous motion-distance; ISM-ang, interspinous motion-angle; SH, segmental height. *p＜0.05, statistically significant differences.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3)Analysis of Cervical Alignment Changes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo significant intergroup differences were observed in sagittal parameter changes from the immediate postoperative period to the final follow-up. However, at the final follow-up, the TMC group exhibited a significantly higher SVA (p = 0.006) and a greater tendency toward increased C7S (p = 0.092) and C2S (p = 0.078) compared to the AVB group (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Comparison of cervical alignment parameters of two groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eAVB Group (n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eTMC Group (n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 617px;\"\u003e\n \u003cp\u003e\u003cem\u003ePreoperation\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC2-7 SVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e16.7\u0026plusmn;12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e21.3\u0026plusmn;10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC2-7 Cobb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e9.2\u0026plusmn;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e7.0\u0026plusmn;11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.665\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC2 Slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e7.0\u0026plusmn;8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e10.3\u0026plusmn;9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC7 Slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e16.2\u0026plusmn;7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e17.3\u0026plusmn;7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 617px;\"\u003e\n \u003cp\u003e\u003cem\u003eImmediate postoperative alignment\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC2-7 Cobb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e9.2\u0026plusmn;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e7.0\u0026plusmn;11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC2-7 SVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e17.9\u0026plusmn;9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e21.4\u0026plusmn;7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC2 Slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e7.1\u0026plusmn;8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e6.5\u0026plusmn;9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.673\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC7 Slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e16.2\u0026plusmn;7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e17.3\u0026plusmn;7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 617px;\"\u003e\n \u003cp\u003e\u003cem\u003eFinal follow-up alignment change (immediate postoperation versus final follow up)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC2-7 Cobb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e11.0\u0026plusmn;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e10.5\u0026plusmn;10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.844\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e△C2-7 Cobb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e-1.0\u0026plusmn;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e-3.4\u0026plusmn;9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC2-7 SVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e13.8\u0026plusmn;8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e19.4\u0026plusmn;9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e△C2-7 SVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e-4.1\u0026plusmn;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e-1.9\u0026plusmn;8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC2 Slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e6.7\u0026plusmn;8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e10.1\u0026plusmn;10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e△C2 Slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e-0.5\u0026plusmn;7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.6\u0026plusmn;11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eC7 Slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e17.6\u0026plusmn;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e20.6\u0026plusmn;7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e△C7 Slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e-1.5\u0026plusmn;5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0.2\u0026plusmn;7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are presented as number (%) or mean\u0026plusmn;standard deviation unless otherwise indicated. AVB, artificial vertebral body; TMC, titanium mesh cage; SVA, sagittal vertical axis. *p＜0.05, statistically significant differences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical Outcomes\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe two groups exhibited comparable preoperative clinical conditions. At the 3-month postoperative follow-up, the AVB group reported significantly lower neck pain (p = 0.029) and NDI scores (p = 0.003) compared to the TMC group, with no significant difference in mJOA scores. Furthermore, the AVB group demonstrated significantly greater NDI improvement (p = 0.002). However, the proportion of patients achieving the MCID for NDI did not significantly differ between groups (AVB: 12/36; TMC: 7/36, p = 0.181).\u003c/p\u003e\n\u003cp\u003eAt the final follow-up, the AVB group continued to show significantly lower neck pain (p = 0.045) and NDI scores (p = 0.001) compared to the TMC group, with no significant difference in mJOA scores. The AVB group also demonstrated significantly greater improvement in NDI (p = 0.011). However, the proportion of patients achieving the MCID for NDI did not differ significantly between groups (AVB: 20/36; TMC: 13/36; p = 0.098) (Table 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe TMC group exhibited a higher revision surgery rate at the final follow-up, although the difference was not statistically significant (p = 0.115). No patients in the AVB group required revision surgery. In contrast, four patients (11.11%) in the TMC group underwent revision procedures: two underwent C3-7 laminoplasty, one underwent C4-5 ACDF for postoperative adjacent segment disease (ASD), and one underwent C3-7 laminoplasty for recurrent myelopathic symptoms. No implant malposition or graft failure was observed in either group (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 Comparison of clinical outcomes of both groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eAVB Group (n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eTMC Group (n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 617px;\"\u003e\n \u003cp\u003e\u003cem\u003ePreoperation\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNeck pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.00\u0026plusmn;2.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.11\u0026plusmn;2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003emJOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e13.94\u0026plusmn;2.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e13.54\u0026plusmn;2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e12.14\u0026plusmn;11.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e10.17\u0026plusmn;8.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.708\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 617px;\"\u003e\n \u003cp\u003e\u003cem\u003e3 months postoperation\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNeck pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2.56\u0026plusmn;1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.64\u0026plusmn;2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.029*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNeck pain alleviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0.44\u0026plusmn;2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e-0.53\u0026plusmn;2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003emJOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e15.86\u0026plusmn;1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e15.03\u0026plusmn;1.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003emJOA improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.92\u0026plusmn;2.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.49\u0026plusmn;1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003emJOARR(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e50.88\u0026plusmn;60.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e39.14\u0026plusmn;41.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e6.58\u0026plusmn;5.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e11.14\u0026plusmn;6.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNDI improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e5.56\u0026plusmn;10.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e-0.97\u0026plusmn;8.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 617px;\"\u003e\n \u003cp\u003e\u003cem\u003eFinal follow-up\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eDuration of follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.34\u0026plusmn;1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.81\u0026plusmn;1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.438\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNeck pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.65\u0026plusmn;2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2.75\u0026plusmn;2.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.045*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNeck pain alleviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.34\u0026plusmn;3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0.44\u0026plusmn;3.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003emJOA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e16.19\u0026plusmn;1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e15.42\u0026plusmn;1.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003emJOA improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2.25\u0026plusmn;2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.88\u0026plusmn;2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.919\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003emJOARR (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e57.84\u0026plusmn;64.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e40.98\u0026plusmn;77.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.36\u0026plusmn;5.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e8.47\u0026plusmn;7.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNDI improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e8.78\u0026plusmn;12.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.72\u0026plusmn;10.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eRevision surgery incidence (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e4(11.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are presented as number (%) or mean\u0026plusmn;standard deviation unless otherwise indicated.\u003c/p\u003e\n\u003cp\u003eAVB, artificial vertebral body; TMC, titanium mesh cage; VAS, Visual Analogue Scale; mJOA, modified Japanese Orthopedic Association; mJOARR, mJOA recovery rate; NDI, Neck Disability Index. *p＜0.05, statistically significant differences.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e3D-printed AVBs have recently emerged as an innovative implant option for ACCF. While several studies suggest theoretical advantages of AVBs, including enhanced osseointegration potential and reduced postoperative subsidence risk [12,15,16,31,32], their clinical benefits remain controversial. Current clinical investigations of AVBs are limited by heterogeneous patient populations (varying surgical segments), short follow-up durations, lack of quantitative fusion assessments, and inadequate control for confounding variables. To address these limitations, we conducted this PSM study comparing mid-term clinical and radiological outcomes between AVB and traditional TMC implants in patients with well-matched baseline characteristics. We implemented multiple fusion assessment modalities, including the novel ISM criteria specifically developed for ACCF. To our knowledge, this represents the first PSM study evaluating mid-term AVB versus TMC outcomes and the first application of ISM fusion criteria in this context.\u003c/p\u003e\u003cp\u003ePrevious studies have reported inconsistent fusion rates for AVB, largely due to variations in assessment criteria. For instance, He et al. reported 100% fusion in the TMC group and 96.4% in the AVB group at a 2-year follow-up using an ISM criterion of \u0026lt;\u0026thinsp;1 mm [16]. However, this threshold, adapted from ACDF, may misestimate the fusion rate [30]. Cheng et al. assessed fusion based on an intervertebral angle change of less than 5\u0026deg; on dynamic radiographs [33], and the one-year fusion rates for AVB and TMC were 95.2% and 95.8%, respectively. Nevertheless, it is noteworthy that the cutoff value for angular change was originally established for ACDF [34]. Moreover, important baseline parameters such as age, follow-up duration, and HU values were not properly matched in these studies, which may significantly affect the comparison of fusion outcomes between groups. In our study, we included only patients who underwent single-level ACCF and used PSM to match patients with similar baseline characteristics to reduce confounding bias. After matching, 36 pairs of patients were identified. Fusion and subsidence were assessed at two time points\u0026mdash;3 months postoperatively and at a minimum 2-year follow-up\u0026mdash;using both a traditional semi-quantitative method (ExGBB) and a quantitative method specifically tailored for ACCF (ISM-dis and ISM-ang) [18,23,24]. Assessed via ExGBB on CT, the two groups showed comparable fusion outcomes at the final follow-up. Assessed by ISM [18], the AVB group demonstrated significantly lower ISM-dis at the 3-month follow-up, although no significant superiority was observed at the final follow-up. Consistent with the ISM-dis findings, the AVB group exhibited significantly less subsidence at the 3-month follow-up, suggesting that AVB implants may provide superior short-term stability. In conclusion, while requiring less bone graft material, the AVB group may achieve comparable mid-term fusion outcomes to TMC and demonstrate better short-term stability. This advantage may prove particularly significant in cases of substantial bone loss, such as those caused by tumors or infections.\u003c/p\u003e\u003cp\u003eSeveral studies have investigated the clinical outcomes of AVB and TMC implants for ACCF; however, no consistent conclusions have been drawn. Li et al. reported that the AVB group exhibited lower neck pain at the 3-month follow-up and higher mJOA scores at both the 3-month and 2-year follow-ups, with no significant difference in NDI [15]. In contrast, He et al. found no significant differences in NDI or mJOA between groups at the 2-year follow-up [16]. In the present study, patients receiving AVBs showed statistically significant improvements in NDI scores at both 3-month and final follow-up assessments compared to the TMC group, while no significant differences in neurological recovery were observed. These discrepancies in clinical outcomes among studies may be attributed to differences in patient populations, follow-up durations, and baseline characteristic control. Furthermore, we suggest that the superior short-term implant stability observed in the AVB group may have contributed to improved neck function by reducing dysfunction associated with surgical segment instability [35,36].\u003c/p\u003e\u003cp\u003eFang and Cheng et al. previously reported greater C2-7 Cobb angles in the AVB group at one-year follow-up compared to the TMC group [10,11]. In the present study, no significant intergroup differences in postoperative C2-7 Cobb angle, C2S, or C7S were observed at the final follow-up. However, the TMC group exhibited a greater SVA and a tendency toward larger increases in both C2S (p\u0026thinsp;=\u0026thinsp;0.078) and C7S (p\u0026thinsp;=\u0026thinsp;0.092) compared to the AVB group. As previous studies have demonstrated positive correlations between both C2S, C2-7 SVA and NDI [37\u0026ndash;41], we suggest that the superior maintenance of sagittal balance in the AVB group may be consistent with the better NDI improvement mentioned above. However, no statistically significant intergroup differences were observed in the proportion of patients achieving the MCID for NDI (6 points, validated for the Chinese population) [22]. Consequently, larger-scale studies with extended follow-up periods are required to assess the long-term clinical efficacy of AVBs. Furthermore, considering the potentially higher costs associated with AVBs, rigorous cost-effectiveness analyses comparing AVBs with TMCs are warranted.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, it is a retrospective cohort study with a limited sample size, introducing unavoidable bias. Second, the follow-up duration was relatively short, potentially limiting the evaluation of long-term outcomes. Additionally, radiological outcomes were not assessed at more postoperative follow-up time points (e.g., 6 months, 1 year), restricting the ability to describe the detailed progression of fusion and subsidence. Future studies with larger sample sizes and extended follow-up periods are planned to further investigate the long-term radiological and clinical outcomes of AVB.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAVB and TMC may achieve comparable mid-term radiological and neurological outcomes in patients with similar baseline characteristics. Requiring less bone graft, AVB may provide superior early stability, evidenced by reduced ISM distances and subsidence.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eACCF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eanterior cervical corpectomy and fusion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eAVB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eartificial vertebral body\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eTMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003etitanium mesh cage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eDCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003edegenerative cervical myelopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003ePSM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003epropensity score matching\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eExGBB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eextra-graft bridging bone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003ecomputed tomography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eISM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003einterspinous motion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eVisual Analogue Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003emJOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eModified Japanese Orthopedic Association\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eNDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eNeck Disability Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eACDF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eanterior cervical discectomy and fusion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e3D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003ethree dimensional\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003ePROM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003epatient reported outcome measures\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eOPLL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eossification of posterior longitudinal ligament\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003emJOARR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eModified Japanese Orthopedic Association recovery rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eMCID\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eminimal clinically important difference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003ePACS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003ePicture Archiving and Communication System\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eHU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eHounsfield unit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eSVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003esagittal vertical axis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eC7S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eC7 Slope\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eC2S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eC2 Slope\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eROI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eregion of interest\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eISM-dis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003einterspinous motion-distance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eISM-ang\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003einterspinous motion-angle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eSH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003esegmental height\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003ebody mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eASD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eadjacent segment disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Review Board of Peking University Third Hospital (M2024132). The requirement for informed consent has been waived by the Ethics Review Board due to the retrospective nature of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHXW, RMQ, and TX were responsible for the study design, data collection and measurement, and manuscript writing. HBG, ZQY, YS, FSZ, SFP, XC, and YBZ assisted with data collection. ZJL and FFZ oversaw and reviewed the study design and manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was partially supported by National Key Research and Development Program of China (2021YFB3800800).\u003c/p\u003e\n\u003cp\u003eWe acknowledge the statistical consultation provided by the Clinical Epidemiology Research Center of Peking University Third Hospital.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYu Z, Shi X, Yin J, Jiang X, Xu N. Comparison of Complications between Anterior Cervical Diskectomy and Fusion versus Anterior Cervical Corpectomy and Fusion in Two- and Three-Level Cervical Spondylotic Myelopathy: A Meta-analysis. J Neurol Surg A Cent Eur Neurosurg. 2023;84(4):343-54.\u003c/li\u003e\n\u003cli\u003eGhogawala Z. Anterior Cervical Option to Manage Degenerative Cervical Myelopathy. Neurosurg Clin N Am. 2018;29(1):83-9.\u003c/li\u003e\n\u003cli\u003eWang M, Yang G, Zhou B, Cao Z, Li Y, Tan J, et al. Anterior cervical controllable Antedisplacement and Fusion (ACAF) versus Anterior Cervical Corpectomy and Fusion (ACCF) for ossification of the cervical posterior longitudinal ligament (OPLL) in Chinese population: a systematic review and meta-analysis. Neurosurg Rev. 2024;47(1):783.\u003c/li\u003e\n\u003cli\u003eYang X, Chen Q, Liu L, Song Y, Kong Q, Zeng J, et al. Comparison of anterior cervical fusion by titanium mesh cage versus nano-hydroxyapatite/polyamide cage following single-level corpectomy. Int Orthop. 2013;37(12):2421-7.\u003c/li\u003e\n\u003cli\u003eJi C, Yu S, Yan N, Wang J, Hou F, Hou T, et al. Risk factors for subsidence of titanium mesh cage following single-level anterior cervical corpectomy and fusion. BMC Musculoskelet Disord. 2020;21(1):32.\u003c/li\u003e\n\u003cli\u003eWang H, Liu Y, Wu T, Yan C, He J, Huang K, et al. Anterior cervical X-shape-corpectomy and fusion vs. anterior cervical corpectomy and fusion for two-level cervical spondylosis. Eur Spine J. 2024;33(1):205-15.\u003c/li\u003e\n\u003cli\u003eFogel GR, Li Z, Liu W, Liao Z, Wu J, Zhou W. In vitro evaluation of stiffness and load sharing in a two-level corpectomy: comparison of static and dynamic cervical plates. Spine J. 2010;10(5):417-21.\u003c/li\u003e\n\u003cli\u003eH\u0026eacute;riveaux Y, Le Cann S, Fraulob M, Vennat E, Nguyen VH, Ha\u0026iuml;at G. Mechanical micromodeling of stress-shielding at the bone-implant interphase under shear loading. Med Biol Eng Comput. 2022;60(11):3281-93.\u003c/li\u003e\n\u003cli\u003eYaqoob K, Amjad I, Munir Awan MA, Liaqat U, Zahoor M, Kashif M. Novel Method for the Production of Titanium Foams to Reduce Stress Shielding in Implants. 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Clin Spine Surg. 2023;36(8):310-6.\u003c/li\u003e\n\u003cli\u003eChung AS, Copay AG, Olmscheid N, Campbell D, Walker JB, Chutkan N. Minimum Clinically Important Difference: Current Trends in the Spine Literature. Spine (Phila Pa 1976). 2017;42(14):1096-105.\u003c/li\u003e\n\u003cli\u003eZhou F, Zhang Y, Sun Y, Zhang F, Pan S, Liu Z. Assessment of the minimum clinically important difference in neurological function and quality of life after surgery in cervical spondylotic myelopathy patients: a prospective cohort study. Eur Spine J. 2015;24(12):2918-23.\u003c/li\u003e\n\u003cli\u003eChien A, Lai DM, Cheng CH, Wang SF, Hsu WL, Wang JL. Responsiveness of the Chinese versions of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire and Neck Disability Index in postoperative patients with cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2015;40(17):1315-21.\u003c/li\u003e\n\u003cli\u003eLee DH, Park S, Hong CG, Park KB, Cho JH, Hwang CJ, et al. Fusion and subsidence rates of vertebral body sliding osteotomy: Comparison of 3 reconstructive techniques for multilevel cervical myelopathy. Spine J. 2021;21(7):1089-98.\u003c/li\u003e\n\u003cli\u003eLee DH, Park S, Lee CS, Hwang CJ, Cho JH, Cho ST. Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Myelopathy: Outcomes at Minimum Five years Follow-up. Spine (Phila Pa 1976). 2023;48(9):600-9.\u003c/li\u003e\n\u003cli\u003eLee J, Lee DH, Jung CW, Song KS. The Significance of Extra-Cage Bridging Bone via Radiographic Lumbar Interbody Fusion Criterion. Global Spine J. 2023;13(1):113-21.\u003c/li\u003e\n\u003cli\u003eMikula AL, Puffer RC, Jeor JDS, Bernatz JT, Fogelson JL, Larson AN, et al. Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes. J Neurosurg Spine. 2020;32(1):50-5.\u003c/li\u003e\n\u003cli\u003ePinter ZW, Reed R, Townsley SE, Mikula AL, Dittman L, Xiong A, et al. Titanium Cervical Cage Subsidence: Postoperative Computed Tomography Analysis Defining Incidence and Associated Risk Factors. Global Spine J. 2023;13(7):1703-15.\u003c/li\u003e\n\u003cli\u003eWang M, Mummaneni PV, Xi Z, Chang CC, Rivera J, Guinn J, et al. Lower Hounsfield units on CT are associated with cage subsidence after anterior cervical discectomy and fusion. J Neurosurg Spine. 2020;33(4):425-32.\u003c/li\u003e\n\u003cli\u003eBalouch E, Burapachaisri A, Woo D, Norris Z, Segar A, Ayres EW, et al. Assessing Postoperative Pseudarthrosis in Anterior Cervical Discectomy and Fusion (ACDF) on Dynamic Radiographs Using Novel Angular Measurements. Spine (Phila Pa 1976). 2022;47(16):1151-6.\u003c/li\u003e\n\u003cli\u003eSong KS, Piyaskulkaew C, Chuntarapas T, Buchowski JM, Kim HJ, Park MS, et al. Dynamic radiographic criteria for detecting pseudarthrosis following anterior cervical arthrodesis. J Bone Joint Surg Am. 2014;96(7):557-63.\u003c/li\u003e\n\u003cli\u003eBurnard JL, Parr WCH, Choy WJ, Walsh WR, Mobbs RJ. 3D-printed spine surgery implants: a systematic review of the efficacy and clinical safety profile of patient-specific and off-the-shelf devices. Eur Spine J. 2020;29(6):1248-60.\u003c/li\u003e\n\u003cli\u003eChoy WJ, Parr WCH, Phan K, Walsh WR, Mobbs RJ. 3-dimensional printing for anterior cervical surgery: a review. J Spine Surg. 2018;4(4):757-69.\u003c/li\u003e\n\u003cli\u003eCheng J, Chen J, Xie L, Feng S, Zhou J, Zhan F. [Treatment of cervical ossification of posterior longitudinal ligament with titanium alloy trabecular bone three-dimensional printed artificial vertebral body]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024;38(5):535-41.\u003c/li\u003e\n\u003cli\u003eKandziora F, Pflugmacher R, Scholz M, Schnake K, Putzier M, Khodadadyan-Klostermann C, et al. Treatment of traumatic cervical spine instability with interbody fusion cages: a prospective controlled study with a 2-year follow-up. Injury. 2005;36 Suppl 2:B27-35.\u003c/li\u003e\n\u003cli\u003eSteilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. Open Orthop J. 2014;8:326-45.\u003c/li\u003e\n\u003cli\u003eZuckerman SL, Devin CJ. Pseudarthrosis of the Cervical Spine. Clin Spine Surg. 2022;35(3):97-106.\u003c/li\u003e\n\u003cli\u003eProtopsaltis TS, Ramchandran S, Tishelman JC, Smith JS, Neuman BJ, Jr GMM, et al. The Importance of C2 Slope, a Singular Marker of Cervical Deformity, Correlates With Patient-reported Outcomes. Spine (Phila Pa 1976). 2020;45(3):184-92.\u003c/li\u003e\n\u003cli\u003ePassfall L, Williamson TK, Krol O, Lebovic J, Imbo B, Joujon-Roche R, et al. Do the newly proposed realignment targets for C2 and T1 slope bridge the gap between radiographic and clinical success in corrective surgery for adult cervical deformity? J Neurosurg Spine. 2022;37(3):368-75.\u003c/li\u003e\n\u003cli\u003eHyun SJ, Kim KJ, Jahng TA, Kim HJ. Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis. Spine (Phila Pa 1976). 2016;41(7):E396-402.\u003c/li\u003e\n\u003cli\u003eKim N, Suk KS, Kwon JW, Seo J, Ju H, Lee BH, et al. Clinical significance of the C2 slope after multilevel cervical spine fusion. J Neurosurg Spine. 2023;38(1):24-30.\u003c/li\u003e\n\u003cli\u003eDivi SN, Bronson WH, Canseco JA, Chang M, Goyal DKC, Nicholson KJ, et al. How do C2 tilt and C2 slope correlate with patient reported outcomes in patients after anterior cervical discectomy and fusion? Spine J. 2021;21(4):578-85.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"anterior cervical corpectomy and fusion, artificial vertebral body, titanium mesh cage, fusion, neck disability index","lastPublishedDoi":"10.21203/rs.3.rs-6940515/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6940515/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003e3D printed artificial vertebral bodies (AVBs) have emerged as a viable alternative to traditional titanium mesh cages (TMCs) for spinal reconstruction following ACCF. However, existing comparative studies evaluating mid-term clinical and radiographic outcomes - particularly those incorporating quantitative assessments of fusion efficacy - remain inconclusive. This study aims to compare clinical and radiological outcomes between AVB and TMC in patients undergoing single-level ACCF with matched baseline characteristics.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003ePatients who underwent single-level ACCF for degenerative cervical myelopathy (DCM) between January 2012 and December 2022, with a minimum of 2-year clinical and radiological follow-up, were included. Patients were grouped by implant type (AVB or TMC), and propensity score matching (PSM) was used to balance baseline characteristics. Outcomes were assessed at 3 months and final follow-up (more than 2 years). Radiological assessments comprised: (1) fusion status evaluated via extra graft bridging bone (ExGBB) on computed tomography (CT) scans and interspinous motion (ISM) parameters; (2) implant subsidence; and (3) cervical alignment changes. Clinical parameters included neck pain (using Visual Analogue Scale), modified Japanese Association (mJOA) score and Neck Disability Index (NDI).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 93 patients were included (49 in AVB and 44 in TMC group). After 1:1 PSM, 36 patients were matched for each group, and intergroup comparisons revealed comparable baseline conditions. At 3 months, the AVB group exhibited significantly smaller ISM distance (p\u0026thinsp;=\u0026thinsp;0.019) and less subsidence (p\u0026thinsp;=\u0026thinsp;0.027) compared to the TMC group. The final follow-up duration was 3.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58 years. At final follow-up, no significant differences in subsidence and cervical alignment maintenance were observed. Furthermore, in fusion status, no significant intergroup differences were found, either in ExGBB or ISM criteria. The two group showed similar neurological recovery and pain alleviation, while the AVB group demonstrated significantly greater 3-month (p\u0026thinsp;=\u0026thinsp;0.002) and final follow-up (p\u0026thinsp;=\u0026thinsp;0.011) NDI improvement. However, no significant differences were observed in the proportion of patients achieving the minimal clinically important difference (MCID) for NDI.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe usage of AVB and TMC resulted in similar fusion outcomes, subsidence and neurological recovery at mid-term. However, AVB might have superior short-term implant stability with less 3-month subsidence and better fusion.\u003c/p\u003e","manuscriptTitle":"Artificial Vertebral Body Versus Titanium Mesh Cage for Single-Level Anterior Cervical Corpectomy and Fusion (ACCF): A Propensity Score Matching Analysis of Fusion, Implant Subsidence and Clinical Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 08:49:49","doi":"10.21203/rs.3.rs-6940515/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-07T15:09:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-30T14:36:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-21T10:03:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-20T03:03:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311108580734112440661438550445798379540","date":"2025-07-15T11:07:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-13T18:22:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320308711560789004777241100758292853694","date":"2025-07-13T17:06:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33290710723466323182988516541073607301","date":"2025-07-09T16:04:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105699249671006324749264436097819539855","date":"2025-07-07T22:27:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-07T15:54:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-30T10:39:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-27T07:32:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-27T07:30:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-06-20T16:10:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ab75cc57-96d2-4c0c-86a1-650e687101f4","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:00:02+00:00","versionOfRecord":{"articleIdentity":"rs-6940515","link":"https://doi.org/10.1186/s12891-025-09308-1","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2025-11-19 15:57:04","publishedOnDateReadable":"November 19th, 2025"},"versionCreatedAt":"2025-07-14 08:49:49","video":"","vorDoi":"10.1186/s12891-025-09308-1","vorDoiUrl":"https://doi.org/10.1186/s12891-025-09308-1","workflowStages":[]},"version":"v1","identity":"rs-6940515","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6940515","identity":"rs-6940515","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}