J Neurosurg Spine 43:42–51, 2025
This study found that after 1- or 2-level TLIF, aggressive disc height restoration and taller interbody implants significantly increase the risk of implant subsidence, especially in patients with poor bone quality. Surgeons should balance correction goals with subsidence risk, particularly in those with low Hounsfield unit measurements.
• This study analyzed predictors of interbody implant subsidence after 1- or 2-level transforaminal lumbar interbody fusion (TLIF) using a time-to-event (survival) analysis.
• Aggressive disc height restoration and use of taller interbody implants significantly increased the risk of subsidence.
• Poor baseline bone quality, measured by lower Hounsfield units (HU) on CT, was a strong independent predictor for significant (≥4 mm) subsidence.
• Longer fusion constructs (more instrumented levels) also increased the risk of significant subsidence.
• No significant association was found between cage material (titanium vs PEEK), device geometry, or lumbopelvic parameters and subsidence risk.
• Subsidence occurred in 38.2% of levels (≥2 mm) and significant subsidence in 10.4% (≥4 mm) by last follow-up.
• Clinical implications suggest balancing correction goals with subsidence risk, especially in patients with poor bone quality.
• Further multicenter and prospective studies are recommended to validate these findings.
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