Comparative review of anchored cage devices and standalone cages in multilevel anterior cervical discectomy and fusion surgeries

Background: Anterior plating has conventionally been the standard for multilevel anterior cervical discectomy and fusion (ACDF). However, concerns about complications linked to plate and screw constructs have prompted interest in alternative solutions such as standalone spacers with or without screws. This study compares clinical and radiological outcomes of standalone cages and anchored cage devices in multilevel ACDF. Methods: A retrospective analysis of 85 patients treated for multilevel ACDF over 5 years at a tertiary spinal center on patients receiving either standalone cages or anchored cage devices. Outcomes assessed included the Odom's Criteria, Neck Disability Index (NDI), Visual Analog Scale (VAS) scores for neck and upper limb pain, fusion rates, subsidence, cobbs angle, C2-C7 SVA, and complications. Statistical analysis utilized t -tests and Chi-square tests with statistical significance set at P < 0.05. Results: A total of 85 patients (46 standalone and 39 anchored cage) with an average follow-up of 3.2 years were included. Both groups exhibited comparable clinical improvements postoperatively. Anchored cage devices had higher fusion rates (91% vs. 88%) but greater subsidence (32.1% vs. 29.0%). Dysphagia incidence was marginally higher in standalone cages. No statistically significant differences in clinical or radiological outcomes were observed. Conclusion: Both standalone cages and anchored cage devices are effective for multilevel ACDF, with comparable short-term outcomes. Device selection should consider surgeon preference, cost, and patient-specific factors. Further long-term studies are needed to validate these findings.