Endplate preparation for anterior cervical discectomy and fusion: does the amount of endplate removed affect cage subsidence risk?
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Purpose:
Subsidence after anterior cervical discectomy and fusion (ACDF) is a common complication that may be influenced by the degree of endplate removal prior to cage insertion. The optimal degree of endplate removal remains unclear; therefore, we performed a series of ex vivo experiments to elucidate the relationship between the aggressiveness of endplate preparation and subsidence risk.
Methods:
Human cadaveric subaxial cervical endplates were partially decorticated either conservatively (n = 10) or aggressively (n = 9). The degree of endplate removal was quantified using microCT. Subsidence was modelled by measuring the strength and stiffness of each specimen when an interbody cage was axially compressed into the endplate.
Results:
Conservative endplate preparation resulted in less endplate removal than aggressive endplate preparation (mass: 150 vs. 301 mg, p < 0.001; volume: 47 vs. 88mm3, p = 0.01; thickness: 0.02 vs. 0.16 mm, p = 0.004). There was no significant difference between the two groups with respect to endplate strength (2.04 vs. 2.04kN, p = 0.99) or stiffness (2.38 vs. 2.41kN/mm, p = 0.89). Bone mineral density (BMD) was similar between the two groups (271.6 vs. 271.9 mg/cm3, p = 0.98) but positively correlated with endplate strength (effect size 0.68, p = 0.001).
Conclusions:
When performing partial cervical endplate decortication, the degree of bony endplate removal did not significantly predict endplate integrity during ex vivo compression testing, but greater BMD was associated with increased strength. The degree of endplate removal should be based on individual patient factors and intraoperative findings to achieve the ideal cage-endplate interface.
Subsidence after anterior cervical discectomy and fusion (ACDF) is a common complication that may be influenced by the degree of endplate removal prior to cage insertion. The optimal degree of endplate removal remains unclear; therefore, we performed a series of ex vivo experiments to elucidate the relationship between the aggressiveness of endplate preparation and subsidence risk.
Methods:
Human cadaveric subaxial cervical endplates were partially decorticated either conservatively (n = 10) or aggressively (n = 9). The degree of endplate removal was quantified using microCT. Subsidence was modelled by measuring the strength and stiffness of each specimen when an interbody cage was axially compressed into the endplate.
Results:
Conservative endplate preparation resulted in less endplate removal than aggressive endplate preparation (mass: 150 vs. 301 mg, p < 0.001; volume: 47 vs. 88mm3, p = 0.01; thickness: 0.02 vs. 0.16 mm, p = 0.004). There was no significant difference between the two groups with respect to endplate strength (2.04 vs. 2.04kN, p = 0.99) or stiffness (2.38 vs. 2.41kN/mm, p = 0.89). Bone mineral density (BMD) was similar between the two groups (271.6 vs. 271.9 mg/cm3, p = 0.98) but positively correlated with endplate strength (effect size 0.68, p = 0.001).
Conclusions:
When performing partial cervical endplate decortication, the degree of bony endplate removal did not significantly predict endplate integrity during ex vivo compression testing, but greater BMD was associated with increased strength. The degree of endplate removal should be based on individual patient factors and intraoperative findings to achieve the ideal cage-endplate interface.
Date Issued
2025-08-01
Date Acceptance
2025-05-24
Citation
European Spine Journal, 2025, 34, pp.3294-3303
ISSN
0940-6719
Publisher
Springer
Start Page
3294
End Page
3303
Journal / Book Title
European Spine Journal
Volume
34
Copyright Statement
© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1007/s00586-025-08997-5
Subjects
Interbody fusion
Cage subsidence
Endplate preparation
Publication Status
Published
Date Publish Online
2025-06-07