Evolving trends in anterior cervical spine surgery: a decade-long shift towards standalone constructs

Background: The current standard of care for operative management of cervical DDD is anterior cervical discectomy and fusion (ACDF). Historically, an anterior plate is used in ACDF to add an additional point of fixation and reduce micromotion between the vertebrae. Recently, standalone cage constructs have gained popularity because of their decreased rates of postoperative dysphagia and similar fusion rates to cage plate constructs. This study aims to analyze the trends in usage of anterior plating in single level, two-level, and three-level ACDF from 2011 to 2022. Methods: A retrospective study was performed using the PearlDiver database. The database was queried for patients who underwent primary ACDF between 2011 and October 2022, and subsequently filtered based on the addition of anterior instrumentation. Trends in the number of cases of ACDF with and without anterior instrumentation were analyzed between 2011 and 2022 and stratified on the number of levels involved. Results: There were 425,288 patients who underwent ACDF from January 2011 to October 2022 after exclusion criteria were applied. The number of single level, two-level, and three-level ACDF without anterior instrumentation performed increased significantly during the study period ( P <0.001). Conclusion: This study highlights the significant shift away from anterior plate usage, especially in two-level ACDF, likely driven by advancements in cervical fusion cage designs and the documented success of standalone constructs. This trend is less pronounced in single-level and three-level ACDFs, likely due to minimal effect on complication rates in single-level and concerns over stability of fusion in three-level ACDF.