Clinical risk factors associated with cage migration after posterior approaches for lumbar interbody fusion: a 10-year systematic review and meta-analysis

Objective Cage migration (CR) after lumbar interbody fusion may result in intractable complications to patients. This meta-analysis was aimed to figure out risk factors of cage migration after posterior approaches for lumbar interbody fusion. Methods Literature was searched in the PubMed, Embase, Web of Science and Cochrane Library between Feb 2013 to Feb 2023. PRISMA guidelines were followed in this review. The keywords used in the search included: cage, retropulsion, migration, lumbar interbody fusion, spinal fusion. Odds ratio (OR) and 95% confidence interval (CI) of a potential risk factor was calculated via RevMan5.4. Results 8 studies were finally included in this meta-analysis. 10 risk factors were assessed and the outcome showed that Screw loosening (OR 12.98, 95% CI 4.63 to 36.36, P < 0.01), endplate injury (OR 10.14, 95% CI 5.20 to 19.79, P < 0.01) and pear-shaped disc (OR 4.03, 95% CI 1.41 to 11.55, P < 0.01) were associated with cage migration, and poly-ether-ether-ketone (PEEK) cage (OR 0.51, 95% CI 0.27 to 0.96, P = 0.04) could reduce risk of cage migration. Conclusion Screw loosening, endplate injury and pear-shaped disc increased risk of CM after posterior approaches for lumbar interbody fusion, and PEEK cage probably reduce risk of postoperative cage migration.