Surgeon perceptions of the complications and value of threaded fusion cages as a spine fusion technique: Results of a consensus survey

Background context: Threaded cage technology has had a meteoric rise in usage. It has been touted as a procedure with low risk and minimal complications. PURPOSE: To gauge the spine surgical community's general consensus regarding cage usage and its complications. Study design/setting: A canvassing questionnaire regarding threaded cage usage and complications was sent to members of the North American Spine Society. Patient sample: A total of 665 doctors reported on their perception of 22,585 cages placed by the second year after pre-market approval from the Food and Drug Administration approval. Outcome measures: A nonscientific canvassing questionnaire was thought to give a consensus of surgical outcome perception in a large number of caregivers with hopes of understanding general trends. Methods: Simple statistical measurements were used to report perceived complications by surgeons involved in performing threaded cage surgical procedures. Results: Sixty-nine percent of doctors reported at least one complication with threaded cages, but the complication incidence was low. Visceral injuries were reported in 0.1%; vascular injuries, 1.0%; cage displacement and dislodgement, 1.4%; temporary and permanent neurologic injuries, 2.25% and 0.56%, respectively; infection 0.34%; retrograde ejaculation 1.2% and revision surgery recorded for 2.7%. Those rating cages as fair to poor (16.5%) were those physicians reporting the longest experience with this technology. Conclusions: The general consensus is that threaded cages have low complication rates and high satisfaction rates, 83.5%. The data represent a convenience sampling and is not scientific.