A cage in the spine: why is it needed and how is it inserted? It is an interbody implant that provides support between vertebrae during fusion. Professor Iakiv Fishchenko will explain the cage's role in your surgical plan, select the construct and discuss endoscopic placement in Kyiv.
What is an interbody cage?
An interbody cage is an implant placed in the prepared space between vertebral bodies after the disc is removed. It maintains the height of the interbody space and supports the segment. Together with bone material, it is used to achieve bony union, or interbody fusion.[1]
Cages vary in shape, support area and height. At the consultation, it is important to understand which level is to be operated on and why interbody support is needed.
An essential component of my interbody fusion technique
In my endoscopic interbody fusion technique, the cage and bone material are essential components.
A porous titanium cage provides support between the vertebrae. Percutaneous screws and rods hold the segment while fusion develops.[2]
For degenerative conditions requiring interbody fusion, we plan both restoration of support and formation of a bony union. Screws alone do not replace the removed disc or perform the cage's function.
How endoscopic lumbar fusion is performed · The cage and pedicle screw fixation
Why I use porous titanium cages
I use porous titanium cages in my practice. Their porous structure provides conditions for contact with bone tissue and bone ingrowth into the cage surface. At the same time, segment support depends on selecting the correct implant size and position.[2]
- Support between vertebrae: maintaining the prepared interbody space.
- Contact with bone: a porous surface for biological integration of the implant.
- Combined with bone material: conditions for fusion to develop in the planned segment.
A randomised study of a specific porous 3D titanium cage model in patients with osteoporosis demonstrated less subsidence than with a PEEK cage. These findings are important when choosing interbody support for reduced bone strength.[3] We consider bone condition and preparation for surgery together with implant selection.
The cage, bone material and screws work together
The construct provides internal stability, while bony fusion develops gradually. Implant placement and completion of fusion are therefore different stages of recovery.[1]
Cages in the lumbar and cervical spine
Lumbar spine
We use a cage within a selected interbody fusion plan for instability, vertebral slippage and other conditions requiring reconstruction of support. With a posterior endoscopic approach, I insert it endoscopically. ALIF uses a different, anterior approach to the interbody space.[4]
Stabilisation for spondylolisthesis · Anterior lumbar interbody fusion — ALIF
Cervical spine
An interbody cage can be part of ACDF — anterior cervical discectomy and fusion. After disc removal and decompression, it supports the space between vertebrae for fusion. We determine the cervical surgical plan and need for additional fixation separately.[5]
How we select a cage and plan its placement
Selection starts with your anatomy and surgical goals. I choose cage shape, height, support area and position according to spinal level, bone condition and the correction required.
- MRI in DICOM format: discs, nerve structures and areas of compression.
- CT, if available: bony anatomy and details of previous surgery.
- X-rays: vertebral position and balance; additional views when indicated.
- A description of symptoms and medical records: previous treatment, discharge summaries and the proposed surgical plan.
If osteoporosis is suspected, we assess bone condition and preparation for construct placement. Bone strength matters for interbody support and maintaining fixation.[6]
How I insert a cage endoscopically
During posterior endoscopic interbody fusion, I use small access points to decompress nerve structures when indicated, remove the disc in the fusion area and prepare the interbody space. I then place bone material and the cage under endoscopic control.
Percutaneous screw fixation complements interbody support. We check construct position using intraoperative imaging. The extent and sequence of steps depend on the chosen operation.[4]
Small access points allow muscle stripping to be limited. Before surgery, we discuss expected benefits and risks, including those involving nerve structures, implant position and subsequent fusion.
Can you have an MRI with a cage?
We use only implants that permit MRI under the manufacturer's specified conditions. Before the scan, tell the MRI professional about your spinal construct.[7]
Activity after cage placement
The team helps with initial standing and walking. Before discharge, you receive advice on everyday movements, exertion and follow-up appointments.
Recovery aims at a gradual return to usual activity while allowing fusion to develop. This takes months; return to work, driving and sport is agreed according to the extent of surgery and rehabilitation progress. More about recovery after spinal fusion.
Questions about interbody cages
Is a cage a mobile artificial disc?
These are different implants with different purposes. A cage provides interbody support and fusion. A mobile artificial disc aims to preserve movement at the operated level; suitability is assessed separately.[8]
Is a cage needed for every disc herniation?
We discuss a cage when interbody fusion is needed. Removing a herniated disc without planned fusion has a different aim. The need for stabilisation is determined by segment condition and the treatment plan.
Does the cage need to be removed later?
A cage is designed to remain in the fusion area long term. Removal is not a routine next stage; further surgery is considered for specific clinical indications.
What determines the cost of surgery with a cage?
The spinal region, number of levels, cage and fixation type, approach and extent of decompression needed. The plan and full cost are clarified after reviewing investigations.
Discuss cage placement with the professor
Send Professor Iakiv Fishchenko existing MRI/CT studies in DICOM format, X-rays and a description of symptoms. Include any existing surgical recommendation. Preliminary review is free. At a consultation in Kyiv, we will discuss the support needed, implant choice and insertion method.
Send your scans to Professor Fishchenko
How to prepare investigations · About the professor · Porous titanium in my practice
Medical sources and the professor's resources
- AAOS OrthoInfo: interbody fusion and the role of the cage.
- Professor Iakiv Fishchenko: porous titanium cages in his own practice.
- Randomised study of porous 3D titanium and PEEK cages, accounting for bone density.
- Professor Iakiv Fishchenko: endoscopic stabilisation and ALIF.
- AAOS OrthoInfo: ACDF and cervical interbody implants.
- CNS: bone assessment before spinal fixation.
- FDA: MRI with implants.
- AAOS OrthoInfo: mobile artificial discs and fusion.