J Neurosurg Spine 44:493–497, 2026
This clinical study evaluates long-term radiographic subsidence after lateral lumbar interbody fusion (LLIF), comparing stand-alone procedures with those augmented by lateral plate and screw fixation. Retrospective analysis of 146 patients (219 levels) with ≥1-year CT follow-up shows lateral plating significantly reduced subsidence odds, while 3D-printed porous titanium cages trended toward lower subsidence than PEEK.
Results note similar reoperation rates between groups, no grade III subsidence, and rare adverse events including one delayed vertebral fracture with plating; methodology included multivariate logistic regression and Marchi subsidence grading. Conclusions support lateral plate and screw fixation, particularly with porous titanium cages, as protective against severe radiographic subsidence.
Objective Assess whether adding lateral plate and screw fixation changes the long-term rate/grade of radiographic cage subsidence after LLIF (excluding posterior instrumented fusion).
Design/Population Retrospective review (2014–2022) of degenerative lumbar spondylosis LLIF cases at two centers; required ≥1-year postoperative CT; 146 patients/219 levels (45% plated, 55% stand-alone).
Subsidence grading Long-term imaging graded by Marchi criteria (grade 0: 0%–24% disc height loss; I: 25%–49%; II: 50%–74%; III: 75%–100%); no intraoperative subsidence included.
Main finding (plating effect) Lateral plate + screws was significantly associated with reduced long-term radiographic subsidence (multivariable OR 0.484, p = 0.006).
Severity pattern All grade II (severe) subsidence cases occurred in the stand-alone LLIF group (4 patients); no grade III subsidence observed.
Cage material trend 3D-printed porous titanium cages trended toward lower subsidence versus PEEK but did not reach statistical significance (OR 0.401, p = 0.071).
Reoperation/fusion No significant difference in reoperation rate between plated and stand-alone groups; radiographic fusion rates were similar (83.1% plated vs 86.4% stand-alone; p = 0.58).
Noted complications/implant details One lateral-plate patient had a delayed vertebral body fracture; plated cases used 18-mm-wide cages, while nearly all stand-alone cases used 22-mm-wide cages.
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