Meta-analysis of the incidence and risk factors for titanium mesh subsidence after anterior cervical corpectomy and fusion

English Keywords:Anterior cervical corpectomy and fusion  Titanium mesh subsidence  Incidence rate  Risk factors

English Abstract:

  【Abstract】 Objectives: To systematically evaluate the incidence and risk factors of titanium mesh subsidence following anterior cervical corpectomy and fusion(ACCF), and to explore the clinical impact of titanium mesh subsidence. Methods: Databases including CNKI, WangFang, VIP, China Biology Medicine disc(CBM), PubMed, Embase, Cochrane Library, and Web of Science were searched for case-control and cohort studies published from the inception of each database to June 2024 about the risk factors of titanium mesh subsidence following ACCF. The Newcastle-Ottawa scale(NOS) was used to assess the quality of the included studies. Basic information(first author, publication year, study type, definition of subsidence, assessment time, sample size, number of subsidence cases, and subsidence incidence), reported risk factors(age, sex, BMI, surgical segment, number of surgical segments, smoking, hypertension, diabetes, fusion segment height, C2-7 Cobb angle, segment angle, vertebral body quality, titanium mesh tilt angle, titanium plate type, screw-plate angle, and titanium mesh placement), cervical JOA score, JOA score improvement rate, and fusion rate were extracted and analyzed using Stata 18.0 software for meta-analysis. Results: A total of 16 studies were included, and all were case-control studies with NOS scores≥7. A total of 1562 patients were included, with 555 cases of titanium mesh subsidence. The meta-analysis showed that the incidence of titanium mesh subsidence after ACCF was 37%. Risk factors for titanium mesh subsidence included older age[MD=2.680, 95%CI(1.228, 4.132), P=0.000], female[OR=0.71, 95%CI(0.56, 0.90), P=0.004], smoking[OR=1.924, 95%CI(1.108, 3.342), P=0.020], osteoporosis[MD=-62.997, 95%CI(-86.670, -39.323), P=0.000], a big number of surgical segments[OR=0.096, 95%CI(0.054, 0.172), P=0.000], posterior placement of titanium mesh[MD=0.743, 95%CI(0.605, 0.968), P=0.026], excessive intervertebral distraction[MD=1.317, 95%CI(0.752, 1.881), P=0.000], segment angle(titanium mesh expansion angle)[MD=0.887, 95%CI(0.117, 1.657), P=0.024], and a big titanium mesh tilt angle[MD=4.475, 95%CI(1.725, 7.225), P=0.001]. Titanium mesh subsidence was associated with a decrease in cervical JOA score[MD=-0.542, 95%CI(-0.947, -0.137), P=0.009], JOA score improvement rate[MD=-11.003, 95%CI(-15.315, -6.691), P=0.000], and cervical fusion rate[OR=3.003, 95%CI(1.019, 8.854), P=0.046]. Conclusions: The current evidence indicates that older age, female, smoking, osteoporosis, a big number of surgical segments, posterior placement of titanium mesh, excessive intervertebral distraction, and big titanium mesh expansion angle(segment angle) and titanium mesh tilt angle are the risk factors for titanium mesh subsidence after ACCF. Cage subsidence after ACCF can impair intervertebral fusion and reduce the overall effectiveness of the surgery, and therefore warrants careful clinical attention.