{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:13:01Z","timestamp":1792782781414,"version":"4.5.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T00:00:00Z","timestamp":1749254400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T00:00:00Z","timestamp":1749254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Back to Back","award":["BMPF_PA6344: 2023 Newell"],"award-info":[{"award-number":["BMPF_PA6344: 2023 Newell"]}]},{"DOI":"10.13039\/501100000266","name":"Engineering & Physical Science Research Council","doi-asserted-by":"crossref","award":["BMPF_P75805: EP\/SO21752\/1"],"award-info":[{"award-number":["BMPF_P75805: EP\/SO21752\/1"]}],"id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Human cadaveric subaxial cervical endplates were partially decorticated either conservatively (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910) or aggressively (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20099). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Conservative endplate preparation resulted in less endplate removal than aggressive endplate preparation (mass: 150 vs. 301\u00a0mg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; volume: 47 vs. 88mm\n                      <jats:sup>3<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01; thickness: 0.02 vs. 0.16\u00a0mm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). There was no significant difference between the two groups with respect to endplate strength (2.04 vs. 2.04kN,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.99) or stiffness (2.38 vs. 2.41kN\/mm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.89). Bone mineral density (BMD) was similar between the two groups (271.6 vs. 271.9\u00a0mg\/cm\n                      <jats:sup>3<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.98) but positively correlated with endplate strength (effect size 0.68,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-025-08997-5","type":"journal-article","created":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T01:18:15Z","timestamp":1749259095000},"page":"3294-3303","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Endplate preparation for anterior cervical discectomy and fusion: does the amount of endplate removed affect cage subsidence risk?"],"prefix":"10.1007","volume":"34","author":[{"given":"Alick","family":"P. Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"D. Slater","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay","family":"A. Raftery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyros D.","family":"Masouros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"A. Levy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"A. Freedman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Newell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,7]]},"reference":[{"key":"8997_CR1","doi-asserted-by":"publisher","first-page":"602","DOI":"10.3171\/jns.1958.15.6.0602","volume":"15","author":"RB Cloward","year":"1958","unstructured":"Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602\u2013617. https:\/\/doi.org\/10.3171\/jns.1958.15.6.0602","journal-title":"J Neurosurg"},{"key":"8997_CR2","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1007\/s00701-018-3490-3","volume":"160","author":"I Noordhoek","year":"2018","unstructured":"Noordhoek I, Koning MT, Jacobs WCH, Vleggeert-Lankamp CLA (2018) Incidence and clinical relevance of cage subsidence in anterior cervical discectomy and fusion: a systematic review. Acta Neurochir (Wien) 160:873\u2013880. https:\/\/doi.org\/10.1007\/s00701-018-3490-3","journal-title":"Acta Neurochir (Wien)"},{"key":"8997_CR3","doi-asserted-by":"publisher","first-page":"1280","DOI":"10.1097\/BRS.0000000000000400","volume":"39","author":"Y-S Lee","year":"2014","unstructured":"Lee Y-S, Kim Y-B, Park S-W (2014) Risk factors for postoperative subsidence of Single-Level anterior cervical discectomy and fusion: the significance of the preoperative cervical alignment. Spine 39:1280. https:\/\/doi.org\/10.1097\/BRS.0000000000000400","journal-title":"Spine"},{"key":"8997_CR4","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1227\/01.NEU.0000197258.30821.50","volume":"58","author":"RHMA Bartels","year":"2006","unstructured":"Bartels RHMA, Donk RD, Feuth T (2006) Subsidence of stand-alone cervical carbon fiber cages. Neurosurgery 58:502\u2013508 discussion 502\u2013508. https:\/\/doi.org\/10.1227\/01.NEU.0000197258.30821.50","journal-title":"Neurosurgery"},{"key":"8997_CR5","doi-asserted-by":"publisher","first-page":"E683","DOI":"10.1097\/BSD.0000000000000315","volume":"30","author":"KW Oh","year":"2017","unstructured":"Oh KW, Lee JH, Lee J-H et al (2017) The correlation between cage subsidence, bone mineral density, and clinical results in posterior lumbar interbody fusion. Clin Spine Surg 30:E683\u2013E689. https:\/\/doi.org\/10.1097\/BSD.0000000000000315","journal-title":"Clin Spine Surg"},{"key":"8997_CR6","doi-asserted-by":"publisher","first-page":"110","DOI":"10.3171\/2013.4.SPINE12319","volume":"19","author":"L Marchi","year":"2013","unstructured":"Marchi L, Abdala N, Oliveira L et al (2013) Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion: clinical Article. SPI 19:110\u2013118. https:\/\/doi.org\/10.3171\/2013.4.SPINE12319","journal-title":"SPI"},{"key":"8997_CR7","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1097\/BSD.0000000000000843","volume":"32","author":"H Igarashi","year":"2019","unstructured":"Igarashi H, Hoshino M, Omori K et al (2019) Factors influencing interbody cage subsidence following anterior cervical discectomy and fusion. Clin Spine Surg 32:297. https:\/\/doi.org\/10.1097\/BSD.0000000000000843","journal-title":"Clin Spine Surg"},{"key":"8997_CR8","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1186\/s12891-015-0546-x","volume":"16","author":"E Chong","year":"2015","unstructured":"Chong E, Pelletier MH, Mobbs RJ, Walsh WR (2015) The design evolution of interbody cages in anterior cervical discectomy and fusion: a systematic review. BMC Musculoskelet Disord 16:99. https:\/\/doi.org\/10.1186\/s12891-015-0546-x","journal-title":"BMC Musculoskelet Disord"},{"key":"8997_CR9","doi-asserted-by":"publisher","first-page":"E1158","DOI":"10.1097\/BRS.0000000000002158","volume":"42","author":"DC Briski","year":"2017","unstructured":"Briski DC, Goel VK, Waddell BS et al (2017) Does spanning a lateral lumbar interbody cage across the vertebral ring apophysis increase loads required for failure and mitigate endplate violation. Spine 42:E1158\u2013E1164. https:\/\/doi.org\/10.1097\/BRS.0000000000002158","journal-title":"Spine"},{"key":"8997_CR10","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1177\/230949901602400122","volume":"24","author":"EM Pinder","year":"2016","unstructured":"Pinder EM, Sharp DJ (2016) Cage subsidence after anterior cervical discectomy and fusion using a cage alone or combined with anterior plate fixation. J Orthop Surg (Hong Kong) 24:97\u2013100. https:\/\/doi.org\/10.1177\/230949901602400122","journal-title":"J Orthop Surg (Hong Kong)"},{"key":"8997_CR11","doi-asserted-by":"publisher","first-page":"615","DOI":"10.31616\/asj.2021.0424","volume":"16","author":"M Lin","year":"2022","unstructured":"Lin M, Paul R, Shapiro SZ et al (2022) Biomechanical study of cervical endplate removal on subsidence and migration in multilevel anterior cervical discectomy and fusion. Asian Spine J 16:615\u2013624. https:\/\/doi.org\/10.31616\/asj.2021.0424","journal-title":"Asian Spine J"},{"key":"8997_CR12","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1097\/00007632-200104150-00021","volume":"26","author":"TH Lim","year":"2001","unstructured":"Lim TH, Kwon H, Jeon CH et al (2001) Effect of endplate conditions and bone mineral density on the compressive strength of the graft-endplate interface in anterior cervical spine fusion. Spine (Phila Pa 1976) 26:951\u2013956. https:\/\/doi.org\/10.1097\/00007632-200104150-00021","journal-title":"Spine (Phila Pa 1976)"},{"key":"8997_CR13","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1007\/s00586-002-0455-1","volume":"11","author":"H Li","year":"2002","unstructured":"Li H, Zou X, Laursen M et al (2002) The influence of intervertebral disc tissue on anterior spinal interbody fusion: an experimental study on pigs. Eur Spine J 11:476\u2013481. https:\/\/doi.org\/10.1007\/s00586-002-0455-1","journal-title":"Eur Spine J"},{"key":"8997_CR14","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1097\/00002517-199804000-00002","volume":"11","author":"G Slappey","year":"1998","unstructured":"Slappey G, Toribatake Y, Ganey TM et al (1998) Guidelines to decortication in posterolateral spine fusion. J Spinal Disord 11:102\u2013109","journal-title":"J Spinal Disord"},{"key":"8997_CR15","doi-asserted-by":"publisher","first-page":"e76843","DOI":"10.1371\/journal.pone.0076843","volume":"8","author":"Y Hou","year":"2013","unstructured":"Hou Y, Yuan W, Kang J, Liu Y (2013) Influences of endplate removal and bone mineral density on the Biomechanical properties of lumbar spine. PLoS ONE 8:e76843. https:\/\/doi.org\/10.1371\/journal.pone.0076843","journal-title":"PLoS ONE"},{"key":"8997_CR16","unstructured":"The American College of Radiology (2023) ACR\u2013SPR\u2013SSR practice guideline for the performance of quantitative computed tomography (QCT) bone densitometry. Revised 2023 (Resolution 15)."},{"key":"8997_CR17","doi-asserted-by":"publisher","first-page":"E4","DOI":"10.3171\/2014.5.FOCUS1483","volume":"37","author":"JJ Schreiber","year":"2014","unstructured":"Schreiber JJ, Anderson PA, Hsu WK (2014) Use of computed tomography for assessing bone mineral density. FOC 37:E4. https:\/\/doi.org\/10.3171\/2014.5.FOCUS1483","journal-title":"FOC"},{"key":"8997_CR18","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1007\/s00402-014-2047-z","volume":"134","author":"T-H Kao","year":"2014","unstructured":"Kao T-H, Wu C-H, Chou Y-C et al (2014) Risk factors for subsidence in anterior cervical fusion with stand-alone polyetheretherketone (PEEK) cages: a review of 82 cases and 182 levels. Arch Orthop Trauma Surg 134:1343\u20131351. https:\/\/doi.org\/10.1007\/s00402-014-2047-z","journal-title":"Arch Orthop Trauma Surg"},{"key":"8997_CR19","doi-asserted-by":"publisher","first-page":"175","DOI":"10.3758\/bf03193146","volume":"39","author":"F Faul","year":"2007","unstructured":"Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175\u2013191. https:\/\/doi.org\/10.3758\/bf03193146","journal-title":"Behav Res Methods"},{"key":"8997_CR20","doi-asserted-by":"publisher","first-page":"1852","DOI":"10.1097\/BRS.0b013e31811ece5a","volume":"32","author":"C-C Cheng","year":"2007","unstructured":"Cheng C-C, Ordway NR, Zhang X et al (2007) Loss of cervical endplate integrity following minimal surface Preparation. Spine 32:1852\u20131855. https:\/\/doi.org\/10.1097\/BRS.0b013e31811ece5a","journal-title":"Spine"},{"key":"8997_CR21","doi-asserted-by":"publisher","first-page":"2104","DOI":"10.1007\/s00586-007-0482-z","volume":"16","author":"NR Ordway","year":"2007","unstructured":"Ordway NR, Lu Y-M, Zhang X et al (2007) Correlation of cervical endplate strength with CT measured subchondral bone density. Eur Spine J 16:2104\u20132109. https:\/\/doi.org\/10.1007\/s00586-007-0482-z","journal-title":"Eur Spine J"},{"key":"8997_CR22","doi-asserted-by":"publisher","unstructured":"Palepu V, Helgeson MD, Molyneaux-Francis M, Nagaraja S (2019) The effects of bone microstructure on subsidence risk for ALIF, LLIF, PLIF, and TLIF spine cages. J Biomech Eng 141. https:\/\/doi.org\/10.1115\/1.4042181","DOI":"10.1115\/1.4042181"},{"key":"8997_CR23","doi-asserted-by":"publisher","first-page":"25","DOI":"10.5115\/acb.20.269","volume":"54","author":"G Schr\u00f6der","year":"2021","unstructured":"Schr\u00f6der G, Jabke B, Schulze M et al (2021) A comparison, using X-ray micro-computed tomography, of the architecture of cancellous bone from the cervical, thoracic and lumbar spine using 240 vertebral bodies from 10 body donors. Anat Cell Biology 54:25\u201334. https:\/\/doi.org\/10.5115\/acb.20.269","journal-title":"Anat Cell Biology"},{"key":"8997_CR24","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1007\/s00586-006-0284-8","volume":"16","author":"P Barsa","year":"2007","unstructured":"Barsa P, Suchomel P (2007) Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J 16:1395\u20131400. https:\/\/doi.org\/10.1007\/s00586-006-0284-8","journal-title":"Eur Spine J"},{"key":"8997_CR25","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1093\/milmed\/usaa338","volume":"186","author":"YMS Purushothaman","year":"2021","unstructured":"Purushothaman YMS, Humm J, Jebaseelan D, Yoganandan N (2021) Neck vertebral Level-specific forces and moments under G-x accelerative loading. Mil Med 186:625\u2013631. https:\/\/doi.org\/10.1093\/milmed\/usaa338","journal-title":"Mil Med"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-025-08997-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-025-08997-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-025-08997-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T18:17:46Z","timestamp":1757182666000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-025-08997-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,7]]},"references-count":25,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["8997"],"URL":"https:\/\/doi.org\/10.1007\/s00586-025-08997-5","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,7]]},"assertion":[{"value":"25 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 May 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 May 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 June 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}