Comparison of expandable and titanium cages in anterior cervical corpectomy for OPLL with osteoporosis: A retrospective matched study

Anterior cervical corpectomy and fusion (ACCF) is commonly used to treat cervical ossification of the posterior longitudinal ligament (OPLL). In patients with concurrent osteoporosis, titanium cage fusion (TCF) may lead to increased implant subsidence and poorer early outcomes. Novel expandable artificial vertebral body fusion (NEAVBF) systems have been developed to address these challenges by offering improved intraoperative adjustability and biomechanical support. To compare clinical and radiographic outcomes of NEAVBF and TCF in osteoporotic patients with cervical OPLL undergoing single-level ACCF. Retrospective cohort study with 1:1 propensity score matching. Eighty-two patients with cervical OPLL and osteoporosis (41 in each group) who underwent single-level ACCF and completed at least 2 years of follow-up. Radiographic outcomes included C2 to C7 Cobb angle, implant subsidence, and fusion rate. Clinical outcomes included Visual Analogue Scale, Neck Disability Index, Japanese Orthopaedic Association (JOA) score, and JOA recovery rate at preoperative, 6-month, and 2-year follow-up. Outcomes were compared between groups at preoperative, 6-month, and 2-year time points. Both groups showed significant improvements in pain and neurological function. At 6 months, NEAVBF resulted in lower Visual Analogue Scale (P < .001), higher JOA scores (P = .013), and greater recovery rate (P < .001), while Neck Disability Index scores were similar (P = .065). Cervical lordosis improved more in the NEAVBF group at 6 months (P = .038) and 2 years (P = .004). Implant subsidence was less common in the NEAVBF group at 6 months (12.2% vs 31.7%, P = .060) and 2 years (26.8% vs 53.7%, P = .024). Although 6-month fusion rates were higher in the NEAVBF group (70.7% vs 51.2%, P = .112), both groups reached similar fusion at 2 years (97.6% vs 92.7%, P = .616). Both NEAVBF and TCF provided favorable long-term outcomes. However, NEAVBF demonstrated superior early cervical alignment, neurological recovery, and reduced implant subsidence, supporting its value in osteoporotic patients with cervical OPLL.