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Purpose <p>Cage subsidence is a primary complication following anterior cervical discectomy and fusion (ACDF). Although several studies have identified risk factors for cage subsidence, most have focused on bone mineral density (BMD), with less attention given to stress factors. The stiffness of cervical spine soft tissues, which is reflected in the range of motion (ROM), may influence stress at the cage–endplate interface. This study aimed to evaluate the impact of preoperative cervical ROM on cage subsidence and cervical sagittal alignment (CSA).</p> Methods <p>We retrospectively reviewed patients who underwent ACDF between 2021 and 2024. The differences in cervical lordosis (CL) and segment angle (SA) between ​preoperative flexion and extension radiographs represented the global range of motion (GROM) and segment range of motion (SROM), respectively. CSA included CL and cervical sagittal vertical axis (cSVA). Cage subsidence was defined as a decrease in segmental height (SH) of more than 2&#xa0;mm. Multivariate logistic regression analysis was used to identify independent risk factors for subsidence. A receiver operating characteristic (ROC) curve was constructed to determine the area under the curve (AUC) and the optimal ROM cut-off value for predicting subsidence. Patients were then categorized into stiffness and flexibility groups based on this cut-off value. Subsidence and CSA were compared between the two groups.</p> Results <p>This study included 80 patients with 131 levels. The subsidence group had significantly higher age and cSVA compared to the non-subsidence group. The subsidence group showed significantly lower T-scores, GROM, and SROM than the non-subsidence group. Multivariate logistic regression identified lower T-score and GROM as independent risk factors for subsidence, while other variables were not significant. A GROM cut-off value of 35.25° was established to differentiate between stiffness and flexibility groups. Preoperative CSA was significantly worse in the stiffness group compared to the flexibility group. However, there was no significant difference in CSA between the two groups postoperatively. Compared to the preoperative period, the CSA in the stiffness group showed significant improvement postoperatively, but the improvement in the flexible group was not significant.</p> Conclusion <p>Lower preoperative GROM was identified as a novel independent risk factor for cage subsidence after ACDF. Patients with preoperative cervical stiffness exhibited worse sagittal alignment, but ACDF with a plate-cage construct effectively restored their cervical alignment.</p>

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Is preoperative cervical range of motion associated with cage subsidence after anterior cervical discectomy and fusion?

  • 期刊论文

  • 发表日期：

    2026年4月7日

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  • Chengkun Zhao,
  • Shijie Wang,
  • Jingjing Zhang,
  • Hegang Niu,
  • Yun Cao,
  • Cailiang Shen,
  • Yinshun Zhang

摘要

Purpose

Cage subsidence is a primary complication following anterior cervical discectomy and fusion (ACDF). Although several studies have identified risk factors for cage subsidence, most have focused on bone mineral density (BMD), with less attention given to stress factors. The stiffness of cervical spine soft tissues, which is reflected in the range of motion (ROM), may influence stress at the cage–endplate interface. This study aimed to evaluate the impact of preoperative cervical ROM on cage subsidence and cervical sagittal alignment (CSA).

Methods

We retrospectively reviewed patients who underwent ACDF between 2021 and 2024. The differences in cervical lordosis (CL) and segment angle (SA) between ​preoperative flexion and extension radiographs represented the global range of motion (GROM) and segment range of motion (SROM), respectively. CSA included CL and cervical sagittal vertical axis (cSVA). Cage subsidence was defined as a decrease in segmental height (SH) of more than 2 mm. Multivariate logistic regression analysis was used to identify independent risk factors for subsidence. A receiver operating characteristic (ROC) curve was constructed to determine the area under the curve (AUC) and the optimal ROM cut-off value for predicting subsidence. Patients were then categorized into stiffness and flexibility groups based on this cut-off value. Subsidence and CSA were compared between the two groups.

Results

This study included 80 patients with 131 levels. The subsidence group had significantly higher age and cSVA compared to the non-subsidence group. The subsidence group showed significantly lower T-scores, GROM, and SROM than the non-subsidence group. Multivariate logistic regression identified lower T-score and GROM as independent risk factors for subsidence, while other variables were not significant. A GROM cut-off value of 35.25° was established to differentiate between stiffness and flexibility groups. Preoperative CSA was significantly worse in the stiffness group compared to the flexibility group. However, there was no significant difference in CSA between the two groups postoperatively. Compared to the preoperative period, the CSA in the stiffness group showed significant improvement postoperatively, but the improvement in the flexible group was not significant.

Conclusion

Lower preoperative GROM was identified as a novel independent risk factor for cage subsidence after ACDF. Patients with preoperative cervical stiffness exhibited worse sagittal alignment, but ACDF with a plate-cage construct effectively restored their cervical alignment.