- 2025-07-01
- Clinical spine surgery 39(2)
Study Design
- Type
- Meta-Analysis
- Sample size
- n = 1,403
- Population
- 1403 patients who had undergone TLIF
- Methods
- A comprehensive search across PubMed, Scopus, Embase, and Google Scholar; pooled OR, SMD, and 95% CI; I² statistic; random-effects or fixed-effects model; funnel plots
Study design
A systematic review and meta-analysis.Background summary
Cage subsidence (CS) is a common complication following transforaminal lumbar interbody fusion (TLIF) surgery.Objective
This study aimed to identify and analyze risk factors associated with CS following TLIF.Methods
A comprehensive search was conducted across PubMed, Scopus, Embase, and Google Scholar for studies published up to March 31, 2024. Pooled odds ratios (OR), standardized mean differences (SMD), and 95% CI were calculated for each identified risk factor. Interstudy heterogeneity was evaluated using the I ² statistic, and either a random-effects or fixed-effects model was applied as appropriate. Publication bias was assessed through funnel plots.Results
Nine studies, comprising data on 1403 patients who had undergone TLIF, were included in the final analysis. Significant risk factors for CS included age (SMD=0.27; 95% CI: 0.12-0.41) and bony endplate injury (OR=7.52; 95% CI: 2.08-27.17). However, no significant associations were found with other potential risk factors, such as cage height, body mass index (BMI), bone mineral density, smoking status, diabetes, sex, center point ratio (CPR), disc height (preprocedure and postprocedure), or surgery location.Conclusion
This meta-analysis identified older age and injury to the bony endplate as significant risk factors for CS after TLIF. These findings may help inform clinical decision-making and guide risk stratification in patients considering TLIF.