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Purpose <p>Traditionally, interbody cages feature a central cavity for graft packing. However, for bioactive glass-ceramic (BGS-7) spacers achieving fusion via surface-mediated osseointegration, this cavity may be biologically redundant and structurally disadvantageous. We compared radiological and clinical outcomes of plated anterior cervical discectomy and fusion (ACDF) using BGS-7 spacers with or without a central cavity.</p> Methods <p>We retrospectively reviewed patients undergoing plated ACDF using solid non-cavity (17 patients, 24 levels) or central-cavity (17 patients, 33 levels) BGS-7 spacers. Radiographic fusion was evaluated using dynamic interspinous distance (primary, ≤ 2&#xa0;mm) and segmental angular motion (secondary, ≤ 4°), alongside CT-based osseointegration (direct contact ≥ 50%). Subsidence (≥ 2&#xa0;mm) and clinical outcomes were evaluated at 12 months.</p> Results <p>Both groups demonstrated comparable 12-month clinical improvements (<i>p</i> &gt; 0.05). Radiographic fusion rates were equivalent between non-cavity and central-cavity groups based on the primary distance (91.7% vs. 84.8%, <i>p</i> = 0.687) and secondary angular criteria (79.2% vs. 63.6%, <i>p</i> = 0.331). The non-cavity group showed a trend toward superior segmental stability, with a smaller dynamic gap distance (0.82 ± 0.64&#xa0;mm vs. 1.53 ± 1.99&#xa0;mm, <i>p</i> = 0.064). CT-based fusion perfectly matched (90.5% vs. 90.9%, <i>p</i> = 1.000). Subsidence rates were comparably low (12.5% vs. 12.1%), with no spacer breakage.</p> Conclusions <p>In plated ACDF, adding a central cavity to BGS-7 spacers confers no measurable advantage over the solid design. Solid spacers inherently preserve maximum endplate contact area for optimal load-sharing and surface-mediated fusion. Eliminating the cavity and supplemental grafts avoids logical redundancy, donor-site morbidity, and unnecessary healthcare costs.</p>

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Is a central cavity necessary for bioactive glass-ceramic spacers in plated ACDF? A retrospective comparison of solid versus cavity designs

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月18日

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  • Tae Hoon Kang,
  • Geumho Lee,
  • Byungjun Kang,
  • Jeongwoon Han,
  • Minjoon Cho,
  • Jae Hyup Lee

摘要

Purpose

Traditionally, interbody cages feature a central cavity for graft packing. However, for bioactive glass-ceramic (BGS-7) spacers achieving fusion via surface-mediated osseointegration, this cavity may be biologically redundant and structurally disadvantageous. We compared radiological and clinical outcomes of plated anterior cervical discectomy and fusion (ACDF) using BGS-7 spacers with or without a central cavity.

Methods

We retrospectively reviewed patients undergoing plated ACDF using solid non-cavity (17 patients, 24 levels) or central-cavity (17 patients, 33 levels) BGS-7 spacers. Radiographic fusion was evaluated using dynamic interspinous distance (primary, ≤ 2 mm) and segmental angular motion (secondary, ≤ 4°), alongside CT-based osseointegration (direct contact ≥ 50%). Subsidence (≥ 2 mm) and clinical outcomes were evaluated at 12 months.

Results

Both groups demonstrated comparable 12-month clinical improvements (p > 0.05). Radiographic fusion rates were equivalent between non-cavity and central-cavity groups based on the primary distance (91.7% vs. 84.8%, p = 0.687) and secondary angular criteria (79.2% vs. 63.6%, p = 0.331). The non-cavity group showed a trend toward superior segmental stability, with a smaller dynamic gap distance (0.82 ± 0.64 mm vs. 1.53 ± 1.99 mm, p = 0.064). CT-based fusion perfectly matched (90.5% vs. 90.9%, p = 1.000). Subsidence rates were comparably low (12.5% vs. 12.1%), with no spacer breakage.

Conclusions

In plated ACDF, adding a central cavity to BGS-7 spacers confers no measurable advantage over the solid design. Solid spacers inherently preserve maximum endplate contact area for optimal load-sharing and surface-mediated fusion. Eliminating the cavity and supplemental grafts avoids logical redundancy, donor-site morbidity, and unnecessary healthcare costs.