Early outcomes of stand-alone cage anterior cervical discectomy and fusion: A comparative analysis with cage-plate fixation in a developing spine practice

Background: Stand-alone cage constructs are becoming popular in the context of anterior cervical discectomy and fusion (ACDF) because they are associated with decreased morbidity of the operation and less dysphagia. There is inconsistent comparative evidence between stand-alone cage and cage-plate ACDF constructs at the single level. This study aims to compare both clinical and radiologic outcomes between stand-alone and cage-plate ACDF in patients undergoing single-level cervical surgery. Methods: Forty sequential single-level ACDF cases were analyzed (stand-alone cage, n = 20; cage-plate, n = 20). Results were Visual Analog Scale (VAS)-Neck, VAS-Arm, and Neck Disability Index (NDI). Radiologic evaluation consisted of segmental lordosis, C2–C7 Cobb angle, fusion, subsidence, and adjacent segment degeneration (ASD). The statistical significance was determined as P < 0.05. Results: Stand-alone ACDF tended to be significantly shorter in terms of operation time (62.7 ± 10.1 vs. 73.8 ± 10.7 min; P < 0.001) and lower in terms of blood loss (47.2 ± 11.8 vs. 68.1 ± 14.9 mL; P < 0.001). Postoperative NDI was significantly better in the stand-alone group (18.4 ± 6.2 vs. 23.3 ± 7.5; P = 0.01). Cage-plate constructs maintained the lordosis of the segments in a better way (P < 0.01). There were similar rates of fusion (95% vs. 100%; P = 0.31). The cage-plate group had significantly more dysphagia and ASD (P = 0.03 and P = 0.04, respectively). Conclusion: Stand-alone ACDF will provide lower morbidity of the operation, decreased rates of dysphagia, and lower rates of ASD without notable differences in fusion and functional outcomes. Cage-plate constructions are still beneficial in preserving lordosis of the segment. The two constructs offer a good solution to single-level pathology.