Anterior Cervical Discectomy and Fusion with Polyetheretherketone Cage or Anterior Cervical Plate: A Comparative Evaluation of Short-term Outcomes

Anterior Cervical Discectomy and Fusion with Polyetheretherketone Cage or Anterior Cervical Plate: A Comparative Evaluation of Short-term Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anterior Cervical Discectomy and Fusion with Polyetheretherketone Cage or Anterior Cervical Plate: A Comparative Evaluation of Short-term Outcomes Vikramaditya Rai, Vipin Sharma, Mukesh Kumar, Lokesh Thakur This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7270486/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Anterior cervical discectomy and fusion (ACDF) is a widely used procedure for treating cervical spondylotic myelopathy and radiculopathy. While anterior cervical plating (ACP) is the traditional method to ensure stability and fusion, it may be associated with increased dysphagia, adjacent segment degeneration, and hardware complications. Stand-alone polyetheretherketone (PEEK) cages offer a potential alternative with reduced operative morbidity. However, comparative evidence regarding their short-term clinical and radiological outcomes remains limited. Methods Current ambispective cohort study encompassed 29 patients with cervical radiculopathy or radiculomyelopathy at C3-C7 levels. Group A (n = 14) underwent ACDF with standalone PEEK cage, while Group B (n = 15) underwent conventional ACDF with ACP. Clinical outcomes were determined by employing Visual Analog Scale (VAS) scores, Neck Pain Disability Index (NPDI), blood loss, operation time, Odom's criteria, and postoperative dysphagia. Radiological outcomes included fusion rates, cervical Cobb’s lordosis, and cage subsidence, assessed at 1, 3, and 6 months post-surgery. Results Both groups exhibited significant post-surgical improvements in NPDI and VAS scores (P 0.05). Group A exhibited shorter operation times and less blood loss (P 0.05). However, Group A exhibited relatively greater cage subsidence, cervical lordosis, loss of disc height, as well as fused segment angle (P < 0.05). Conclusion ACDF with stand-alone PEEK cages demonstrated clinical outcomes comparable to ACDF with ACP fixation but showed higher rates of postoperative complications, including loss of cervical lordosis and cage subsidence. Anterior cervical discectomy and fusion PEEK cage ACDF anterior cervical plating cervical radiculopathy cervical myelopathy standalone cage fusion rate dysphagia cervical lordosis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background ACDF aims to achieve bony union, restore cervical lordosis, and decompress spinal cord as well as nerve roots. Traditionally, surgeons have utilized anterior cervical plating (ACP) to provide immediate rigid fixation and improve arthrodesis rates [ 1 – 2 ]. However, plating has potential drawbacks, including hardware complications, increased risk of adjacent segment degeneration, and higher incidence of dysphagia and dysphonia, particularly in multilevel procedures [ 3 – 7 ]. To address these concerns, self-locking cage systems have been developed as an alternative to conventional plating. These standalone devices aim to provide similar biomechanical stability while reducing soft tissue manipulation and anterior bulk [ 8 – 9 ]. Various materials, including titanium, carbon, and polyetheretherketone (PEEK), are used in these cage designs. The predominant drawback associated with standalone cage implementation is the increased frequency of nonunion, implant subsidence, diminished cervical lordosis, and pseudarthrosis development [ 10 – 12 ]. A recent meta-analysis of 10 RCTs encompassing 779 patients reported that ACDF with stand-alone spacers outperformed conventional instrumentation in terms of estimated blood loss, total postoperative complications, dysphagia rates and adjacent segment disease [ 13 ]. Moreover, conclusive evidence was absent regarding the superior intermediate-term efficacy of standalone cages versus ACP constructs in ACDF procedures [ 14 ]. Despite numerous studies comparing standalone cages to plated ACDF constructs, a consensus on the superiority of one technique over the other has not been reached. Current investigation aimed to enhance current body of evidence by evaluating and comparing clinical and radiological outcomes of ACDF performed with standalone PEEK cages versus the traditional technique involving ACP. Materials and Methods Patient selection Current ambispective cohort study was carried out at a tertiary care hospital, from June 2021 to June 2023. A total of 29 patients between ages of 37-60yrs, who received single or two-level ACDF were included. Inclusion criteria encompass: (1) clinical signs and symptoms of cervical spondylotic myelopathy or cervical radiculopathy unresponsive to non-invasive treatment, (2) age between 18-65yrs, (3) disc herniation confirmed by magnetic resonance imaging (MRI) or computed tomography (CT) showing nerve root or spinal cord compression and (4) involvement of 1 or 2 contiguous disc levels from C3-C4 to C6-C7. Exclusion criteria encompassed C-spine fractures, prior cervical surgery, three or more segment diseases, predominant posterior pathology, infections, neoplasms, and refusal of consent. After obtaining ethical approval and informed consent from all the individual participants, enrolled patients underwent clinical examination, radiography, and MRI. They were randomized into 2 groups: Group A, comprising 14patients (12 males; 2 females) with age 50.07 ± 9.92yrs (range 38–63) underwent ACDF with stand-alone PEEK cage and Group B, consisting of 15patients (8 males; 7 females) with age 48.87 ± 11.36 years (range 36–61) underwent conventional ACDF with ACP. Mean follow-up time in Group A was 6.5 ± 7.2months and in Group B was 7.2 ± 8.7months. Complete follow-up was achieved for all participants, with no significant demographic disparities identified between study groups (Table 1 ). Table 1 Baseline characteristics of the study population Age (Years) Gender (Male/Female) Follow-up time Levels (C3-C5/C6-C7) Operation Time (Min) Blood Loss (ml) Group A 50.07 ± 9.92 12/2 6.5 ± 7.2 8/6 103.5 ± 27.2 132.7 ± 31.6 Group B 48.87 ± 11.36 8/7 7.2 ± 8.7 7/8 128.4 ± 32.3 157.2 ± 39.3 p-value 0.764 0.109 0.638 0.532 0.017 0.015 Surgical technique/devices Surgeries were conducted using Smith-Robinson cervical fusion technique [ 2 ], with the patient, under general anesthesia, positioned supine on the operating table and a small roll placed under the interscapular region. The ACDF with ACP involves a meticulous approach to the cervical spine through an anterior incision. After careful dissection and exposure of the appropriate level, confirmed radiographically, a complete discectomy was performed. The endplates were meticulously prepared, preserving the subchondral bone while removing all cartilaginous material. A tricortical iliac crest autograft was harvested and precisely fitted to the intervertebral space, ensuring proper depth and alignment. For aminotomies and osteophyte removal was performed as necessary. The graft was then placed, recessed slightly from the anterior vertebral cortex. An ACP was applied to enhance stability. Intraoperative radiographs confirmed proper positioning of the graft and hardware before closure. Postoperatively, patients were immobilized in Philadelphia hard cervical collars for 3 months. The ACDF with standalone PEEK cage followed a similar initial approach and exposure. After confirming the correct operative level radiographically, a thorough discectomy was conducted encompassing removal of posterior longitudinal ligament, any compressive disc material, and osteophytes. The endplates underwent preparation through curettage and rasping techniques. The appropriate cage size was determined using trial spacers. The chosen PEEK cage was packed with autologous cancellous bone graft and meticulously positioned within the intervertebral space (Fig. 1 ). Fluoroscopic imaging was employed to confirm appropriate device placement. With plating technique, patients were prescribed Philadelphia hard cervical collar for 3months postoperatively, followed by neck range of motion physiotherapy. Follow-up evaluations are conducted at 1, 3, and 6 months post-surgery to assess healing and functional outcomes. Patients were discharged between the third and fifth postoperative days. Outcome measures Clinical and radiological follow-ups were carried out at 1, 3, and 6 months post-surgery. Spinal alignment, as well as fusion status was determined by employing anteroposterior as well as lateral radiographs. Fusion was described as presence of bridging trabecular bone between endplates, lack of implant failure signs, and less than 50% radiolucency surrounding cage. Cervical lordotic curvature was assessed through Cobb angle determination from the C2 to C7 inferior endplate landmarks (Fig. 2 ). Primary outcome measures included VAS scores for neck and shoulder pain, handgrip strength, muscle power, NPDI, neck range of motion (ROM), Swallowing Quality of Life Questionnaire (SWAL-Qol) score, Cervical Spine Functional Score (CSFS), arthrodesis, Odom's criteria, as well as cervical lordosis correction. Secondary outcomes encompass dysphagia, implant subsidence or displacement, fusion rates, and complications. Intraoperative and post-operative data were also collected. Statistical Analysis Categorical variables were indicated as numbers and percentages, while quantitative data were expressed as mean ± standard deviations (SD) and medians with interquartile (IQR) ranges (25th-75th percentiles). Data normality was evaluated by employing Shapiro-Wilk test. Non-parametric tests were utilised for non-normally distributed data. For quantitative variables, we applied Mann-Whitney test for non-normally distributed data along with Independent t-test for normally distributed data. Qualitative variables were analyzed by employing Chi-Square test, while Fisher's exact test was utilised when expected cell values were found to be less than 5. Data entry was done by employing Microsoft Excel, and final analyses were done by employing IBM SPSS Statistics version-25.0 (Chicago, USA). For all analyses, p-value < 0.05 was considered statistically significant. Results Clinical outcome assessment In Group A, eight patients underwent C3-C5 fusion and six underwent C6-C7 fusion by employing standalone PEEK cages. In Group B, seven patients had C3-C5 fusion and eight had C6–C7 fusion with use of an ACP, with insignificant differences observed between groups. Neither group experienced perioperative complications such as cerebrospinal fluid leakage, cage migration, hematoma, wound infection, or plate-related issues. Group A had a shorter operative time (103.5 ± 27.2 minutes) and less blood loss (132.7 ± 31.6 ml) compared to Group B (128.4 ± 32.3 minutes; 157.2 ± 39.3 ml), with both differences being statistically significant (P < 0.05) (Table 1 ). Mild dysphagia was reported by 4 patients in Group A and 6 in Group B within 24 hours post-surgery. Among these, 3patients in Group A and 4 in Group B recovered within 2weeks, while remaining 1patient in Group A and 2 in Group B resolved spontaneously by 1 month postoperatively. At final follow-up, none of the patients in either group experienced dysphagia, and there was insignificant difference in dysphagia rates between the groups at any time point. Surgical outcomes, as assessed by Odom’s criteria, demonstrated insignificant differences among groups (Table 2 ). Table 2 Results of surgery according to Odom’s criteria Group A Group B Description Excellent 7 12 All preoperative symptoms resolved, and abnormal findings showed improvement. Good 7 3 Slight persistence of preoperative symptoms. Fair 0 0 Notable relief of certain preoperative symptoms, while others remained unchanged or showed minor improvement. Poor 0 0 Symptoms and signs remained the same or worsened. p- value 0.128 Functional outcomes We assessed various parameters at 1, 3, and 6 months post-operatively (Fig. 2 ). VAS for neck pain demonstrated insignificant differences among two groups at any time point (p > 0.05). At one month, median VAS score for the plating group was 2 (range 0–6) compared to 2 (range 1–7) for the PEEK cage group. By 6 months, both groups had a median score of 0, indicating substantial pain reduction in both groups. Similarly, VAS scores for shoulder pain demonstrated insignificant differences among groups at any follow-up (p > 0.05). Median scores at 1 month were 2 for both groups, reducing to 0 for both groups at 3 and 6 months. Muscle power improved in both groups over time, with insignificant differences observed among 2 groups at any follow-up (p > 0.05). Mean muscle power at 1 month was 3.67 ± 1.05 for the plating group and 3.71 ± 0.91 for the PEEK cage group. By 6 months, these values had increased to 4.53 ± 0.92 and 4.64 ± 0.84, respectively. The NPDI scores showed progressive improvement in both groups, with insignificant differences between them at any time point (p > 0.05) (Fig. 3 ). At 1 month, the median NPDI score for the plating group was 28 (range 20–90) compared to 34 (range 20–92) for the PEEK cage group. By 6 months, these had reduced to 18 (range 9–63) and 18 (range 13–71), respectively. The SWAL -QoL scores improved over time in both groups, with insignificant differences between them (p > 0.05). Mean scores at 1 month were 29.47 ± 8.78 for the plating group and 28.43 ± 8.82 for the PEEK cage group. At the 6-month mark, these values declined to 13.27 ± 6.35 and 13.29 ± 4.97, respectively, suggesting enhanced swallowing function in both groups. Neck flexion, extension, and rotation were assessed at each follow-up. For neck flexion, the percentage of patients having normal range rose from 73.33% at 1 month to 80% at 6 months in the plating group, and from 57.14–85.71% in the PEEK cage group. Similar improvements were observed for neck extension. Interestingly, all patients in both groups demonstrated normal left and right cervical rotation at all follow-ups. Insignificant differences were observed between groups for any of these parameters (p > 0.05). Handgrip strength showed gradual improvement in both groups. For the left hand, the percentage of patients with normal grip strength increased from 86.67% at 1 month to 86.67% at 6 months in the plating group, and from 78.57–85.71% in the PEEK cage group. For the right hand, these percentages were 80–80% for the plating group and 64.29–71.43% for the PEEK cage group. Group outcomes were comparable, with statistically insignificant variation (p > 0.05). CSFS percentage decreased over time in both groups, indicating functional improvement. At one month, the median CSFS was 30.7% for the plating group and 11.05% for PEEK cage group. At 6-month follow-up, these rates had decreased to 14.2% and 3%, respectively. Nevertheless, the observed differences did not achieve statistical significance (p > 0.05). Odom's criteria showed progressive improvement in both groups. At one month, 53.33% of patients in plating group and 42.86% in PEEK cage group had good or excellent outcomes. At 6 months, fusion rates reached 100% in both the plating group and the PEEK cage group. Insignificant differences were found between groups at any follow-up (p > 0.05). Radiographic outcomes We assessed implant positioning, Cobb's angle, and fusion status at several time points post-operatively. Throughout the 6-month follow-up period, no instances of implant malpositioning or subsidence were observed in either group. This suggests that both techniques provided stable implant positioning over the study period. Cervical lordosis was evaluated using Cobb angle measurements (Fig. 4 ). Preoperatively, the mean Cobb's angle was 18.29 ± 6.32° for group A and 16.73 ± 6.43° for group B. At one month post-operatively, both groups demonstrated significant rise in Cobb's angle compared to preoperative values (p < 0.05 for both groups). Mean Cobb's angle rose to 24.07 ± 2.05° in the plating group and 24.29 ± 1.9° in the PEEK cage group. This improvement in cervical lordosis was maintained at 3 and 6 months post-operatively, with insignificant changes found after 1-month mark. Importantly, there were insignificant differences in Cobb's angle among 2 groups at any post-operative time point (p = 0.768 at 1, 3, and 6 months). This suggests that both techniques were equally effective in improving and maintaining cervical lordosis. Fusion status was assessed at 6 months post-operatively (Fig. 5 ). In ACP group, 13 out of 15 patients (86.67%) achieved arthrodesis, while in the PEEK cage group, 12 out of 14 patients (85.71%) achieved fusion. Statistically insignificant differences in fusion rates among two groups (p = 1.00) were observed. Number of patients who did not achieve fusion by 6 months was small and comparable between groups: 2 patients (13.33%) in plating group and 2patients (14.29%) in PEEK cage group. Complications At one month post-surgery, 11 out of 15 patients in ACP group and 9 out of 14 in PEEK Cage group reported no complications. Bone graft site pain affected 2 patients in each group, while eczema due to cervical collar use was observed in 2 ACP patients and 3 PEEK Cage patients. These differences were statistically insignificant (p = 0.857, Fisher's exact test). By 3 months, complications had notably decreased. Only 1 patient in each group reported persistent bone graft site pain and eczema cases resolved completely. The differences remained statistically insignificant (p = 1, Fisher's exact test). At the 6-month follow-up, all 29 patients across both groups reported no complications, indicating similar and favorable long-term outcomes for both groups. Discussion Various surgical techniques are available for ACDF, with iliac bone autografts commonly used.One common concern with these grafts is morbidity at the donor site. As a result, interbody fusion using cage fixation has become a popular alternative. Many studies have compared outcomes between cage-only fixation and conventional plate fixation (Table 3 ), with most reporting no significant differences in clinical outcomes. Nevertheless, research by Vaishnav et al. [ 15 ] and Zavras et al. [ 16 ] showed significantly better VAS scores in the plate fixation group for single-level ACDF. These differences may be linked to factors such as changes in cervical lordosis due to cage subsidence [ 22 – 24 ] or increased posterior cervical tension from pseudoarthrosis. Table 3 Review of previous studies comparing stand-alone cage and conventional plate fixation (at the end of 6 months followup) Study Level Clinical and radiological outcomes (group A Vs. group B) NPDI VAS Odom’s Criteria Fusion rate (%) Subsidence (%) Vaishnav et al. [ 15 ] 1–2 No significant difference group A > group B - - - Zavras et al. [ 16 ] 1–2 Worse for plate group group A > group B - 90.0 vs. 90.0 4.0 vs. 0.0 Lan et al. [ 17 ] 1 - No significant difference No significant difference - - Kim et al. [ 18 ] 1 - - No significant difference 97.9 vs. 97.9 13.0 vs. 18.0 Nemoto et al. [ 19 ] 1 - No significant difference No significant difference 91.0 vs. 95.0 16.0 vs. 13.0 Noh et al. [ 20 ] 1 No significant difference - No significant difference 95.0 vs. 94.0 13.0 vs. 37.0 He et al. [ 21 ] 1 No significant difference - - 100.0 vs. 100.0 9.6 vs. 9.0 Although certain studies have not demonstrated a clear link between subsidence and clinical outcomes, Lee et al. observed that increased subsidence was linked to less favorable results [ 25 ]. Earlier research comparing fusion rates, subsidence, and kyphosis suggested that cage-only fixation was linked to lower fusion rates but higher rates of subsidence and kyphosis. Notably, the success of fusion decreased with an increasing number of surgical levels [ 24 , 26 , 27 ]. These findings suggest that cage-only constructs may offer less stable vertebral fixation than conventional plate fixation [ 28 , 29 ]. In this study, we compared clinical and radiological outcomes between single- and two-level ACDF using PEEK cages versus conventional anterior plate fixation. Our results revealed significant differences in blood loss and operation time, with the cage group showing lower values, consistent with outcomes by Zavras et al. [ 16 ] and Nemoto et al. [ 19 ]. In contrast, Doo Kyung et al. [ 30 ] reported higher blood loss with conventional plate fixation. Although stand-alone cages have demonstrated comparable clinical outcomes to plate fixation in multi-level procedures, differences in blood loss and operation time remain debated [ 3 , 8 , 31 ]. The reduced blood loss in the cage fixation group may be attributed to less extensive preparation required for the anterior vertebral surface. Both surgical approaches in our study showed similar improvements in symptoms and structural integrity. Significant improvements in NDI and VAS scores were observed in both groups, with substantial restoration of cervical lordosis and favorable surgical efficacy. No significant differences were found in fusion rates, subsidence rates, physical function, or postoperative complications, supporting the findings of Zavras et al. [ 16 ], Kim et al. [ 18 ], Noh et al. [ 20 ], and He et al. [ 21 ]. Regarding swallowing outcomes, Swallowing Quality of Life (SWAL-QoL) scores enhanced in both groups over time, with insignificant differences at the final follow-up. These outcomes align with those of Nemoto et al., who similarly reported insignificant differences in dysphagia rates among groups [ 19 ]. In contrast, Zavras et al. [ 16 ] reported poorer swallowing outcomes in the plate group at both six weeks and six months, whereas Lan et al. [ 17 ] found a lower rate of postoperative dysphagia in cage group. He et al. [ 21 ] also found differences in dysphagia rates at one and three months, though these differences diminished by 12 months. In their studies on ACDF with plate vs PEEK cage in degenerative cervical myelopathy, Zavras et al. [ 16 ] and Nemoto et al. [ 19 ] concluded that both approaches were effective for managing single- and two-level cervical spondylotic myelopathy. Plate patients reported worse swallow function but cage-plate construct had better postoperative cervical spine alignment and stability [ 16 , 19 ]. Zhu et al. similarly reported that stand-alone cages demonstrated safety and efficacy in multilevel spinal procedures, but the conventional plate fixation was good for patients requiring more postoperative stability and improved cervical alignment [ 32 ]. There are limitations to current investigation, such as small sample size, which limits our ability for confirming statistical equivalence among groups, particularly for long-term outcomes such as adjacent segment disease (ASD) and arthrodesis rates. This limitation may also explain the minimal changes in physical component scores observed beyond six months postoperatively, despite no significant intergroup differences. Additionally, some loss to follow-up, especially with radiographic data, and the study's relatively short duration of six months may not capture potential long-term differences between the two techniques. Conclusion Current investigation found that both ACDF with stand-alone PEEK cages and conventional ACDF with ACP are equally effective and safe surgical options for treating degenerative cervical spine conditions. The choice between these two methods should depend on patient-specific factors and surgeon preference, as both offer similar outcomes concerning fusion rates, functional recovery, pain relief, and complication rates. Future investigation with larger sample sizes and longer follow-up periods is required for confirming these outcomes and evaluate potential long-term differences among two approaches. Declarations Acknowledgements: Not applicable. Funding No funding or sponsorship was received for this study or publication of this article. Declaration of Interest The authors declare that they have no competing interests. Ethics/ Ethics Approval Not applicable Consent to Participate Declaration : Not applicable. Consent to Publish Declaration : Not applicable Code Availability: No datasets were generated or analyzed during the current study. Availability of Data and Materials : No new data were generated or analyzed in this study. All data supporting this review are derived from previously published sources, which have been appropriately cited. Author Contribution : VR and MK -writing original draft, methodology, visualization; SMC and NC - writing original draft, methodology, visualization; LT - methodology, visualization, data collection; VS- supervision, review and editing. All the authors approved the final version to be published. References Connolly PJ, Esses SI, Kostuik JP. Anterior cervical fusion: outcome analysis of patients fused with and without anterior cervical plates. Clin Spine Surg.1996;9:202–206. Wang JC, McDonough PW, Endow KK, Kanim LE, Delamarter RB. Increased fusion rates with cervical plating for two – level anterior cervical discectomy and fusion. Spine. 2000;25:41–45. Yang L, Gu Y, Liang L, Gao R, Shi S, Yuan W. Standalone anchored spacer versus anterior plate for multi – level anterior cervical discectomy anf fusion. Orthopedics. 2012;35:e1503 – e1510. Chung JY, Kim SK, Jung ST, LEE KB,et al. Clinical adjacent – segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10 – year follow – up. Spins J. 2014; 14:2290–2298. Brodke DS, Klimo P Jr, Bachus KN. Anterior cervical fixation: analysis of load – sharing and stability with use of static and dynamic plates. J Bone Joint Surg Am. 2006; 88: 156–1573. Epstein NE. A review of complication rates for anterior cervical discectomy and fusion (ACDF). Surg Neurol Int. 2019;10:100–108. Garg R, Rath GP, Bithal PK, Prabhakar H, Marda MK,et al. Effects of retract or application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion. Indian J Anaesth. 2010; 54:292–295. Wang Z, Zhu R, Yang H, Shen M, Wang G, Chen K, et al. Zero – profile implant (Zero – p) versus plate cage benezech implant (PCB) in the treatment of single – level, cervical spondylotic myelopathy. BMC Musculoskelet Disord. 2015;16:290. Hofsetter CP, Kesavabhotla K, Bookvar JA. Zero – profile anchored spaer reduces rate of dysphagia compared with acdf with anterior plating. J Spinal Disord Tech. 2015;28:284–90. Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP. The efcacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine. 2009;34(26):2886–92 Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine. 2002;27(22):2453–8. Nambiar M, Phan K, Cunningham JE, Yang Y, Turner PL, Mobbs R. Locking stand-alone cages versus anterior plate constructs in single-level fusion for degenerative cervical disease: a systematic review and meta-analysis. Eur Spine J. 2017;26(9):2258–66 Jake M. McDonnell, Salma Youssef, Tayler D. Ross, Harry Marland, Luke Turley, Gráinne Cunniffe, Stacey Darwish, Joseph S. Butler. The efficacy of anchored stand-alone spacers in comparison to conventional cage and plate in anterior cervical discectomy and fusion surgery: A meta-analysis of randomised controlled trials for clinical and radiological outcomes. Brain and Spine. 2024;4:102748. https://doi.org/10.1016/j.bas.2024.102748 . Li Z, Zhao Y, Tang J, Ren D, Guo J, Wang H, et al. A comparison of a new zero-profle, stand-alone Fidji cervical cage and anterior cervical plate for single and multilevel ACDF: a minimum 2-year follow-up study. Eur Spine J. 2017;26(4):1129–39 Vaishnav AS, Saville P, McAnany S, et al. Predictive factors of postoperative dysphagia in single-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 2019;44:E400–E407. doi: 10.1097/BRS.0000000000002865 . Zavras AG, Nolte MT, Sayari AJ, Singh K, Colman MW. Stand-alone cage versus anterior plating for 1-level and 2-level anterior cervical discectomy and fusion. Clin Spine Surg.2022;35(4):155–165 Lan T, Lin JZ, Hu SY, et al. Comparison between Zero-profile spacer and plate with cage in the treatment of single level cervical spondylosis. J Back Musculoskelet Rehabil. 2018;31:299–304. doi: 10.3233/BMR-169708 . Kim SJ, Kim SD. Anterior cervical discectomy and fusion using a double cylindrical cage versus an anterior cervical plating system with iliac crest autografts for the treatment of cervical degenerative disc disease. J Korean Neurosurg Soc. 2014;55:12–17. doi: 10.3340/jkns.2014.55.1.12 . Nemoto O, Kitada A, Naitou S, et al. Stand-alone anchored cage versus cage with plating for single-level anterior cervical discectomy and fusion: a prospective, randomized, controlled study with a 2-year follow-up. Eur J Orthop Surg Traumatol. 2015;25(Suppl 1):S127–S134. doi: 10.1007/s00590-014-1547-4 . Noh SH, Park JY, Kuh SU, et al. Comparison of zero-profile anchored spacer versus plate-and-cage after 1-Level ACDF with complete uncinate process resection. Clin Spine Surg. 2021;34:176–182. doi: 10.1097/BSD.0000000000001129 . He S, Zhou Z, Lv N, et al. Comparison of clinical outcomes following anterior cervical discectomy and fusion with zero-profile anchored spacer-ROI-C-fixation and combined intervertebral cage and anterior cervical discectomy and fusion: a retrospective study from a single center. Med Sci Monit. 2021;27:e931050. doi: 10.12659/MSM.931050 . Oh K, Lee CK, You NK, Kim SH, Cho KH: Radiologic changes of anterior cervical discectomy and fusion using allograft and plate augmentation: comparison of using fixed and variable type screw. Korean J Spine 10: 160–164, 2013 Park SB, Chung CK, Lee SH, Yang HJ, Son YJ, Chung YS: The impact of menopause on bone fusion after the single-level anterior cervical discectomy and fusion. J Korean Neurosurg Soc 54: 496–500, 2013 Pereira EA, Chari A, Hempenstall J, Leach JC, Chandran H, Cadoux-Hudson TA: Anterior cervical discectomy plus intervertebral polyetheretherketone cage fusion over three and four levels without plating is safe and effective long-term. J Clin Neurosci 20: 1250–1255, 2013 Lee YS, Kim YB, Park SW: Risk factors for postoperative subsidence of single-level anterior cervical discectomy and fusion: the significance of the preoperative cervical alignment. Spine (Phila Pa 1976) 39: 1280–1287, 2014 El-Tantawy A: Is it possible to eliminate the plate-related problems and still achieve satisfactory outcome after multilevel anterior cervical discectomy? Eur J Orthop Surg Traumatol 25(Suppl 1):135–145, 2015 Song KJ, Taghavi CE, Lee KB, Song JK, Eun JP: The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976) 34: 2886–2892, 2009 Kast E, Derakhshani S, Bothmann M, Oberle J: Subsidence after anterior cervical inter-body fusion. A randomized prospective clinical trial. Neurosurg Rev 32: 207–214; discussion 214, 2009 Resnick DK, Trost GR: Use of ventral plates for cervical arthrodesis. Neurosurgery 60(1 Suppl 1):S112-S117, 2007 Doo Kyung S, Wuk SD, Ho Sang K, et al. Comparative study 331 of clinical and radiological outcomes of a zero-profile device 332 concerning reduced postoperative Dysphagia after single level 333 anterior cervical discectomy and fusion. Journal of Korean 334 Neurosurgical Society 2014; 56: 103–7 Chen Y, Chen H, Cao P, et al. Anterior cervical interbody 336 fusion with the Zero-P spacer: mid-term results of two-level 337 fusion. European Spine Journal: Official Publication of the 338 European Spine Society, the European Spinal Deformity Soci- 339 ety, and the European Section of the Cervical Spine Research 340 Society 2015; 24: 1666-72. Zhu D, Zhong D, Liu B, Li C, Zhu J. Can self- locking cages offer the same clinical outcomes as anterior cage-with-plate fixation for 3-level anterior cervical discectomy and fusion (ACDF) in mid-term follow-up. Med Sci Monit.2019;25:547–557 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7270486","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":501589409,"identity":"84ef59cb-dc9f-4910-847b-04cfa310b45a","order_by":0,"name":"Vikramaditya Rai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYFACxgYgkgCzHgAJHj6itfAwMDAbgLSwEWsRSAsb2C6CWszbDzd/+LjDQs6evflZ5dccOxk2BuaHj27g0SJzJrHBcOYZCWMenmNmt2W3JQMdxmZsnINHiwRDYkMyb5tEYo9EDtttyW3MQC08bNJ4tfA/bDgM1iL/hq1Ycls9EVokEhubIbbwsDF+3HaYGC0PmxnBfjmTZizNuO04DxszIb/wpz8GhlidHHv74Ycff26rtudnb374GJ8WFMDMAyaJVQ4CjD9IUT0KRsEoGAUjBgAAmrdASsShvpAAAAAASUVORK5CYII=","orcid":"","institution":"Dr. Rajendra Prasad Government Medical College","correspondingAuthor":true,"prefix":"","firstName":"Vikramaditya","middleName":"","lastName":"Rai","suffix":""},{"id":501589410,"identity":"02c52369-8f27-42b1-8e22-e5122c25da1d","order_by":1,"name":"Vipin Sharma","email":"","orcid":"","institution":"Dr. Rajendra Prasad Government Medical College","correspondingAuthor":false,"prefix":"","firstName":"Vipin","middleName":"","lastName":"Sharma","suffix":""},{"id":501589411,"identity":"5fe69674-1f25-40ca-b83b-8b9952d43fd6","order_by":2,"name":"Mukesh Kumar","email":"","orcid":"","institution":"Dr. Rajendra Prasad Government Medical College","correspondingAuthor":false,"prefix":"","firstName":"Mukesh","middleName":"","lastName":"Kumar","suffix":""},{"id":501589412,"identity":"31fd3c73-3746-4488-bad9-4745eee0dc72","order_by":3,"name":"Lokesh Thakur","email":"","orcid":"","institution":"Dr. Rajendra Prasad Government Medical College","correspondingAuthor":false,"prefix":"","firstName":"Lokesh","middleName":"","lastName":"Thakur","suffix":""}],"badges":[],"createdAt":"2025-08-01 10:53:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7270486/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7270486/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89659039,"identity":"20bd6b23-1c63-486d-b79c-92ab4d33a268","added_by":"auto","created_at":"2025-08-22 10:51:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":558912,"visible":true,"origin":"","legend":"\u003cp\u003eAnterior cervical discectomy and fusion (ACDF): Intraoperative for cage placement\u003c/p\u003e","description":"","filename":"ACDFresearchpaperFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7270486/v1/713c05cfd0ee8b1c5c3bacd5.png"},{"id":89658623,"identity":"6f82fc6f-3617-4a09-8061-a7cdcc6c8497","added_by":"auto","created_at":"2025-08-22 10:43:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":185500,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e: \u003cstrong\u003eCervical Cobb’s lordosis measurement\u003c/strong\u003e: Determined by the angle formed between the upper endplate of C2 and the lower endplate of C7 in the neutral position (lines a and b).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB:\u003c/strong\u003e \u003cstrong\u003eFused segment angle measurement\u003c/strong\u003e: Calculated as the angle formed between the upper endplate of the superior vertebral body and the lower endplate of the inferior vertebral body in the neutral position (lines c and d).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e: \u003cstrong\u003eDisc height measurement\u003c/strong\u003e: The average of the anterior disc height (ADH) and posterior disc heights (PDH).\u003c/p\u003e","description":"","filename":"ACDFresearchpaperFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7270486/v1/d634c2f372640fdfcfff323b.png"},{"id":89657494,"identity":"c1883ec0-bd7f-44f2-8831-0f2cf558c5fd","added_by":"auto","created_at":"2025-08-22 10:35:30","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":73368,"visible":true,"origin":"","legend":"\u003cp\u003eThe clinical outcomes : VAS neck pain and NPDI Scores at post-operative 1, 3 and 6 months followup.\u003c/p\u003e","description":"","filename":"ACDfresearchpaperFigure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7270486/v1/55a57dab82fe343d799d2817.png"},{"id":89658624,"identity":"ff62c81d-8f93-4263-900f-b23232410e7f","added_by":"auto","created_at":"2025-08-22 10:43:30","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":47474,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of trend of Cobb's angle (degree) at different times of follow-up.\u003c/p\u003e","description":"","filename":"ACDFresearchpaperFigure4Cobbsangle.png","url":"https://assets-eu.researchsquare.com/files/rs-7270486/v1/1331e946ee509c825b4a031b.png"},{"id":89657496,"identity":"6ee2be8e-f41c-4b32-800b-7b29e380a50e","added_by":"auto","created_at":"2025-08-22 10:35:30","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":673229,"visible":true,"origin":"","legend":"\u003cp\u003eRadiograph on post-operative 6\u003csup\u003e \u003c/sup\u003emonths showing fusion in Conventional plate ACDF and standalone PEEK cage\u003c/p\u003e","description":"","filename":"ACDFresearchpaperFigure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7270486/v1/c56007cbf874b46328697dff.png"},{"id":90357224,"identity":"d792772b-fe33-4e2e-b58f-f00c8b38e7b1","added_by":"auto","created_at":"2025-09-01 21:46:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2454279,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7270486/v1/f180a4dd-0745-411a-a0bb-1c7818e5a60d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anterior Cervical Discectomy and Fusion with Polyetheretherketone Cage or Anterior Cervical Plate: A Comparative Evaluation of Short-term Outcomes","fulltext":[{"header":"Background","content":"\u003cp\u003eACDF aims to achieve bony union, restore cervical lordosis, and decompress spinal cord as well as nerve roots. Traditionally, surgeons have utilized anterior cervical plating (ACP) to provide immediate rigid fixation and improve arthrodesis rates [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, plating has potential drawbacks, including hardware complications, increased risk of adjacent segment degeneration, and higher incidence of dysphagia and dysphonia, particularly in multilevel procedures [\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo address these concerns, self-locking cage systems have been developed as an alternative to conventional plating. These standalone devices aim to provide similar biomechanical stability while reducing soft tissue manipulation and anterior bulk [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Various materials, including titanium, carbon, and polyetheretherketone (PEEK), are used in these cage designs.\u003c/p\u003e\u003cp\u003eThe predominant drawback associated with standalone cage implementation is the increased frequency of nonunion, implant subsidence, diminished cervical lordosis, and pseudarthrosis development [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A recent meta-analysis of 10 RCTs encompassing 779 patients reported that ACDF with stand-alone spacers outperformed conventional instrumentation in terms of estimated blood loss, total postoperative complications, dysphagia rates and adjacent segment disease [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, conclusive evidence was absent regarding the superior intermediate-term efficacy of standalone cages versus ACP constructs in ACDF procedures [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite numerous studies comparing standalone cages to plated ACDF constructs, a consensus on the superiority of one technique over the other has not been reached. Current investigation aimed to enhance current body of evidence by evaluating and comparing clinical and radiological outcomes of ACDF performed with standalone PEEK cages versus the traditional technique involving ACP.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003ePatient selection\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Current ambispective cohort study was carried out at a tertiary care hospital, from June 2021 to June 2023. A total of 29 patients between ages of 37-60yrs, who received single or two-level ACDF were included. Inclusion criteria encompass: (1) clinical signs and symptoms of cervical spondylotic myelopathy or cervical radiculopathy unresponsive to non-invasive treatment, (2) age between 18-65yrs, (3) disc herniation confirmed by magnetic resonance imaging (MRI) or computed tomography (CT) showing nerve root or spinal cord compression and (4) involvement of 1 or 2 contiguous disc levels from C3-C4 to C6-C7. Exclusion criteria encompassed C-spine fractures, prior cervical surgery, three or more segment diseases, predominant posterior pathology, infections, neoplasms, and refusal of consent.\u003c/p\u003e\u003cp\u003e After obtaining ethical approval and informed consent from all the individual participants, enrolled patients underwent clinical examination, radiography, and MRI. They were randomized into 2 groups: Group A, comprising 14patients (12 males; 2 females) with age 50.07\u0026thinsp;\u0026plusmn;\u0026thinsp;9.92yrs (range 38\u0026ndash;63) underwent ACDF with stand-alone PEEK cage and Group B, consisting of 15patients (8 males; 7 females) with age 48.87\u0026thinsp;\u0026plusmn;\u0026thinsp;11.36 years (range 36\u0026ndash;61) underwent conventional ACDF with ACP. Mean follow-up time in Group A was 6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2months and in Group B was 7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7months. Complete follow-up was achieved for all participants, with no significant demographic disparities identified between study groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of the study population\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge (Years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003cp\u003e(Male/Female)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFollow-up time\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLevels\u003c/p\u003e\u003cp\u003e(C3-C5/C6-C7)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOperation Time (Min)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBlood Loss (ml)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.07\u0026thinsp;\u0026plusmn;\u0026thinsp;9.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12/2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8/6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e103.5\u0026thinsp;\u0026plusmn;\u0026thinsp;27.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e132.7\u0026thinsp;\u0026plusmn;\u0026thinsp;31.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48.87\u0026thinsp;\u0026plusmn;\u0026thinsp;11.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8/7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e128.4\u0026thinsp;\u0026plusmn;\u0026thinsp;32.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e157.2\u0026thinsp;\u0026plusmn;\u0026thinsp;39.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.764\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.638\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurgical technique/devices\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSurgeries were conducted using Smith-Robinson cervical fusion technique [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], with the patient, under general anesthesia, positioned supine on the operating table and a small roll placed under the interscapular region. The ACDF with ACP involves a meticulous approach to the cervical spine through an anterior incision. After careful dissection and exposure of the appropriate level, confirmed radiographically, a complete discectomy was performed. The endplates were meticulously prepared, preserving the subchondral bone while removing all cartilaginous material. A tricortical iliac crest autograft was harvested and precisely fitted to the intervertebral space, ensuring proper depth and alignment. For aminotomies and osteophyte removal was performed as necessary. The graft was then placed, recessed slightly from the anterior vertebral cortex. An ACP was applied to enhance stability. Intraoperative radiographs confirmed proper positioning of the graft and hardware before closure. Postoperatively, patients were immobilized in Philadelphia hard cervical collars for 3 months.\u003c/p\u003e\u003cp\u003eThe ACDF with standalone PEEK cage followed a similar initial approach and exposure. After confirming the correct operative level radiographically, a thorough discectomy was conducted encompassing removal of posterior longitudinal ligament, any compressive disc material, and osteophytes. The endplates underwent preparation through curettage and rasping techniques. The appropriate cage size was determined using trial spacers. The chosen PEEK cage was packed with autologous cancellous bone graft and meticulously positioned within the intervertebral space (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Fluoroscopic imaging was employed to confirm appropriate device placement. With plating technique, patients were prescribed Philadelphia hard cervical collar for 3months postoperatively, followed by neck range of motion physiotherapy. Follow-up evaluations are conducted at 1, 3, and 6 months post-surgery to assess healing and functional outcomes. Patients were discharged between the third and fifth postoperative days.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcome measures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eClinical and radiological follow-ups were carried out at 1, 3, and 6 months post-surgery. Spinal alignment, as well as fusion status was determined by employing anteroposterior as well as lateral radiographs. Fusion was described as presence of bridging trabecular bone between endplates, lack of implant failure signs, and less than 50% radiolucency surrounding cage. Cervical lordotic curvature was assessed through Cobb angle determination from the C2 to C7 inferior endplate landmarks (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ePrimary outcome measures included VAS scores for neck and shoulder pain, handgrip strength, muscle power, NPDI, neck range of motion (ROM), Swallowing Quality of Life Questionnaire (SWAL-Qol) score, Cervical Spine Functional Score (CSFS), arthrodesis, Odom's criteria, as well as cervical lordosis correction. Secondary outcomes encompass dysphagia, implant subsidence or displacement, fusion rates, and complications. Intraoperative and post-operative data were also collected.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eCategorical variables were indicated as numbers and percentages, while quantitative data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations (SD) and medians with interquartile (IQR) ranges (25th-75th percentiles). Data normality was evaluated by employing Shapiro-Wilk test. Non-parametric tests were utilised for non-normally distributed data. For quantitative variables, we applied Mann-Whitney test for non-normally distributed data along with Independent t-test for normally distributed data. Qualitative variables were analyzed by employing Chi-Square test, while Fisher's exact test was utilised when expected cell values were found to be less than 5. Data entry was done by employing Microsoft Excel, and final analyses were done by employing IBM SPSS Statistics version-25.0 (Chicago, USA). For all analyses, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eClinical outcome assessment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn Group A, eight patients underwent C3-C5 fusion and six underwent C6-C7 fusion by employing standalone PEEK cages. In Group B, seven patients had C3-C5 fusion and eight had C6\u0026ndash;C7 fusion with use of an ACP, with insignificant differences observed between groups. Neither group experienced perioperative complications such as cerebrospinal fluid leakage, cage migration, hematoma, wound infection, or plate-related issues. Group A had a shorter operative time (103.5\u0026thinsp;\u0026plusmn;\u0026thinsp;27.2 minutes) and less blood loss (132.7\u0026thinsp;\u0026plusmn;\u0026thinsp;31.6 ml) compared to Group B (128.4\u0026thinsp;\u0026plusmn;\u0026thinsp;32.3 minutes; 157.2\u0026thinsp;\u0026plusmn;\u0026thinsp;39.3 ml), with both differences being statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Mild dysphagia was reported by 4 patients in Group A and 6 in Group B within 24 hours post-surgery. Among these, 3patients in Group A and 4 in Group B recovered within 2weeks, while remaining 1patient in Group A and 2 in Group B resolved spontaneously by 1 month postoperatively. At final follow-up, none of the patients in either group experienced dysphagia, and there was insignificant difference in dysphagia rates between the groups at any time point. Surgical outcomes, as assessed by Odom\u0026rsquo;s criteria, demonstrated insignificant differences among groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults of surgery according to Odom\u0026rsquo;s criteria\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup A\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup B\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExcellent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAll preoperative symptoms resolved, and abnormal findings showed improvement.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSlight persistence of preoperative symptoms.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNotable relief of certain preoperative symptoms, while others remained unchanged or showed minor improvement.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSymptoms and signs remained the same or worsened.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ep- value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFunctional outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe assessed various parameters at 1, 3, and 6 months post-operatively (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). VAS for neck pain demonstrated insignificant differences among two groups at any time point (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). At one month, median VAS score for the plating group was 2 (range 0\u0026ndash;6) compared to 2 (range 1\u0026ndash;7) for the PEEK cage group. By 6 months, both groups had a median score of 0, indicating substantial pain reduction in both groups. Similarly, VAS scores for shoulder pain demonstrated insignificant differences among groups at any follow-up (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Median scores at 1 month were 2 for both groups, reducing to 0 for both groups at 3 and 6 months.\u003c/p\u003e\u003cp\u003eMuscle power improved in both groups over time, with insignificant differences observed among 2 groups at any follow-up (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Mean muscle power at 1 month was 3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05 for the plating group and 3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91 for the PEEK cage group. By 6 months, these values had increased to 4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92 and 4.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84, respectively. The NPDI scores showed progressive improvement in both groups, with insignificant differences between them at any time point (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). At 1 month, the median NPDI score for the plating group was 28 (range 20\u0026ndash;90) compared to 34 (range 20\u0026ndash;92) for the PEEK cage group. By 6 months, these had reduced to 18 (range 9\u0026ndash;63) and 18 (range 13\u0026ndash;71), respectively.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe SWAL -QoL scores improved over time in both groups, with insignificant differences between them (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Mean scores at 1 month were 29.47\u0026thinsp;\u0026plusmn;\u0026thinsp;8.78 for the plating group and 28.43\u0026thinsp;\u0026plusmn;\u0026thinsp;8.82 for the PEEK cage group. At the 6-month mark, these values declined to 13.27\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35 and 13.29\u0026thinsp;\u0026plusmn;\u0026thinsp;4.97, respectively, suggesting enhanced swallowing function in both groups.\u003c/p\u003e\u003cp\u003eNeck flexion, extension, and rotation were assessed at each follow-up. For neck flexion, the percentage of patients having normal range rose from 73.33% at 1 month to 80% at 6 months in the plating group, and from 57.14\u0026ndash;85.71% in the PEEK cage group. Similar improvements were observed for neck extension. Interestingly, all patients in both groups demonstrated normal left and right cervical rotation at all follow-ups. Insignificant differences were observed between groups for any of these parameters (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eHandgrip strength showed gradual improvement in both groups. For the left hand, the percentage of patients with normal grip strength increased from 86.67% at 1 month to 86.67% at 6 months in the plating group, and from 78.57\u0026ndash;85.71% in the PEEK cage group. For the right hand, these percentages were 80\u0026ndash;80% for the plating group and 64.29\u0026ndash;71.43% for the PEEK cage group. Group outcomes were comparable, with statistically insignificant variation (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eCSFS percentage decreased over time in both groups, indicating functional improvement. At one month, the median CSFS was 30.7% for the plating group and 11.05% for PEEK cage group. At 6-month follow-up, these rates had decreased to 14.2% and 3%, respectively. Nevertheless, the observed differences did not achieve statistical significance (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eOdom's criteria showed progressive improvement in both groups. At one month, 53.33% of patients in plating group and 42.86% in PEEK cage group had good or excellent outcomes. At 6 months, fusion rates reached 100% in both the plating group and the PEEK cage group. Insignificant differences were found between groups at any follow-up (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eRadiographic outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe assessed implant positioning, Cobb's angle, and fusion status at several time points post-operatively. Throughout the 6-month follow-up period, no instances of implant malpositioning or subsidence were observed in either group. This suggests that both techniques provided stable implant positioning over the study period. Cervical lordosis was evaluated using Cobb angle measurements (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Preoperatively, the mean Cobb's angle was 18.29\u0026thinsp;\u0026plusmn;\u0026thinsp;6.32\u0026deg; for group A and 16.73\u0026thinsp;\u0026plusmn;\u0026thinsp;6.43\u0026deg; for group B. At one month post-operatively, both groups demonstrated significant rise in Cobb's angle compared to preoperative values (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for both groups). Mean Cobb's angle rose to 24.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05\u0026deg; in the plating group and 24.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u0026deg; in the PEEK cage group. This improvement in cervical lordosis was maintained at 3 and 6 months post-operatively, with insignificant changes found after 1-month mark. Importantly, there were insignificant differences in Cobb's angle among 2 groups at any post-operative time point (p\u0026thinsp;=\u0026thinsp;0.768 at 1, 3, and 6 months). This suggests that both techniques were equally effective in improving and maintaining cervical lordosis.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFusion status was assessed at 6 months post-operatively (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). In ACP group, 13 out of 15 patients (86.67%) achieved arthrodesis, while in the PEEK cage group, 12 out of 14 patients (85.71%) achieved fusion. Statistically insignificant differences in fusion rates among two groups (p\u0026thinsp;=\u0026thinsp;1.00) were observed. Number of patients who did not achieve fusion by 6 months was small and comparable between groups: 2 patients (13.33%) in plating group and 2patients (14.29%) in PEEK cage group.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAt one month post-surgery, 11 out of 15 patients in ACP group and 9 out of 14 in PEEK Cage group reported no complications. Bone graft site pain affected 2 patients in each group, while eczema due to cervical collar use was observed in 2 ACP patients and 3 PEEK Cage patients. These differences were statistically insignificant (p\u0026thinsp;=\u0026thinsp;0.857, Fisher's exact test). By 3 months, complications had notably decreased. Only 1 patient in each group reported persistent bone graft site pain and eczema cases resolved completely. The differences remained statistically insignificant (p\u0026thinsp;=\u0026thinsp;1, Fisher's exact test). At the 6-month follow-up, all 29 patients across both groups reported no complications, indicating similar and favorable long-term outcomes for both groups.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eVarious surgical techniques are available for ACDF, with iliac bone autografts commonly used.One common concern with these grafts is morbidity at the donor site. As a result, interbody fusion using cage fixation has become a popular alternative. Many studies have compared outcomes between cage-only fixation and conventional plate fixation (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), with most reporting no significant differences in clinical outcomes. Nevertheless, research by Vaishnav et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and Zavras et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] showed significantly better VAS scores in the plate fixation group for single-level ACDF. These differences may be linked to factors such as changes in cervical lordosis due to cage subsidence [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] or increased posterior cervical tension from pseudoarthrosis.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eReview of previous studies comparing stand-alone cage and conventional plate fixation (at the end of 6 months followup)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLevel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u003cp\u003eClinical and radiological outcomes (group A Vs. group B)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNPDI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eVAS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOdom\u0026rsquo;s Criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFusion rate (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSubsidence (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaishnav et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo significant difference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003egroup A\u0026thinsp;\u0026gt;\u0026thinsp;group B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZavras et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWorse for plate group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003egroup A\u0026thinsp;\u0026gt;\u0026thinsp;group B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e90.0 vs. 90.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.0 vs. 0.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLan et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo significant difference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo significant difference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKim et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo significant difference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e97.9 vs. 97.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.0 vs. 18.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNemoto et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo significant difference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo significant difference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e91.0 vs. 95.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16.0 vs. 13.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNoh et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo significant difference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo significant difference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95.0 vs. 94.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.0 vs. 37.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHe et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo significant difference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100.0 vs. 100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.6 vs. 9.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAlthough certain studies have not demonstrated a clear link between subsidence and clinical outcomes, Lee et al. observed that increased subsidence was linked to less favorable results [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Earlier research comparing fusion rates, subsidence, and kyphosis suggested that cage-only fixation was linked to lower fusion rates but higher rates of subsidence and kyphosis. Notably, the success of fusion decreased with an increasing number of surgical levels [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These findings suggest that cage-only constructs may offer less stable vertebral fixation than conventional plate fixation [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, we compared clinical and radiological outcomes between single- and two-level ACDF using PEEK cages versus conventional anterior plate fixation. Our results revealed significant differences in blood loss and operation time, with the cage group showing lower values, consistent with outcomes by Zavras et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and Nemoto et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In contrast, Doo Kyung et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] reported higher blood loss with conventional plate fixation. Although stand-alone cages have demonstrated comparable clinical outcomes to plate fixation in multi-level procedures, differences in blood loss and operation time remain debated [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The reduced blood loss in the cage fixation group may be attributed to less extensive preparation required for the anterior vertebral surface.\u003c/p\u003e\u003cp\u003eBoth surgical approaches in our study showed similar improvements in symptoms and structural integrity. Significant improvements in NDI and VAS scores were observed in both groups, with substantial restoration of cervical lordosis and favorable surgical efficacy. No significant differences were found in fusion rates, subsidence rates, physical function, or postoperative complications, supporting the findings of Zavras et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], Kim et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], Noh et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and He et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRegarding swallowing outcomes, Swallowing Quality of Life (SWAL-QoL) scores enhanced in both groups over time, with insignificant differences at the final follow-up. These outcomes align with those of Nemoto et al., who similarly reported insignificant differences in dysphagia rates among groups [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In contrast, Zavras et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] reported poorer swallowing outcomes in the plate group at both six weeks and six months, whereas Lan et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] found a lower rate of postoperative dysphagia in cage group. He et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] also found differences in dysphagia rates at one and three months, though these differences diminished by 12 months.\u003c/p\u003e\u003cp\u003eIn their studies on ACDF with plate vs PEEK cage in degenerative cervical myelopathy, Zavras et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and Nemoto et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] concluded that both approaches were effective for managing single- and two-level cervical spondylotic myelopathy. Plate patients reported worse swallow function but cage-plate construct had better postoperative cervical spine alignment and stability [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Zhu et al. similarly reported that stand-alone cages demonstrated safety and efficacy in multilevel spinal procedures, but the conventional plate fixation was good for patients requiring more postoperative stability and improved cervical alignment [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere are limitations to current investigation, such as small sample size, which limits our ability for confirming statistical equivalence among groups, particularly for long-term outcomes such as adjacent segment disease (ASD) and arthrodesis rates. This limitation may also explain the minimal changes in physical component scores observed beyond six months postoperatively, despite no significant intergroup differences. Additionally, some loss to follow-up, especially with radiographic data, and the study's relatively short duration of six months may not capture potential long-term differences between the two techniques.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCurrent investigation found that both ACDF with stand-alone PEEK cages and conventional ACDF with ACP are equally effective and safe surgical options for treating degenerative cervical spine conditions. The choice between these two methods should depend on patient-specific factors and surgeon preference, as both offer similar outcomes concerning fusion rates, functional recovery, pain relief, and complication rates. Future investigation with larger sample sizes and longer follow-up periods is required for confirming these outcomes and evaluate potential long-term differences among two approaches.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding or sponsorship was received for this study or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics/ Ethics Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate Declaration\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish Declaration\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode Availability:\u0026nbsp;\u003c/strong\u003eNo datasets were generated or analyzed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e: No new data were generated or analyzed in this study. All data supporting this review are derived from previously published sources, which have been appropriately cited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e: VR and MK -writing original draft, methodology, visualization; SMC and NC - writing original draft, methodology, visualization; LT - methodology, visualization, data collection; VS- supervision, review and editing. All the authors approved the final version to be published.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eConnolly PJ, Esses SI, Kostuik JP. Anterior cervical fusion: outcome analysis of patients fused with and without anterior cervical plates. Clin Spine Surg.1996;9:202\u0026ndash;206.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang JC, McDonough PW, Endow KK, Kanim LE, Delamarter RB. Increased fusion rates with cervical plating for two \u0026ndash; level anterior cervical discectomy and fusion. Spine. 2000;25:41\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang L, Gu Y, Liang L, Gao R, Shi S, Yuan W. Standalone anchored spacer versus anterior plate for multi \u0026ndash; level anterior cervical discectomy anf fusion. Orthopedics. 2012;35:e1503 \u0026ndash; e1510.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChung JY, Kim SK, Jung ST, LEE KB,et al. Clinical adjacent \u0026ndash; segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10 \u0026ndash; year follow \u0026ndash; up. Spins J. 2014; 14:2290\u0026ndash;2298.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrodke DS, Klimo P Jr, Bachus KN. Anterior cervical fixation: analysis of load \u0026ndash; sharing and stability with use of static and dynamic plates. J Bone Joint Surg Am. 2006; 88: 156\u0026ndash;1573.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEpstein NE. A review of complication rates for anterior cervical discectomy and fusion (ACDF). Surg Neurol Int. 2019;10:100\u0026ndash;108.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarg R, Rath GP, Bithal PK, Prabhakar H, Marda MK,et al. Effects of retract or application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion. Indian J Anaesth. 2010; 54:292\u0026ndash;295.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Z, Zhu R, Yang H, Shen M, Wang G, Chen K, et al. Zero \u0026ndash; profile implant (Zero \u0026ndash; p) versus plate cage benezech implant (PCB) in the treatment of single \u0026ndash; level, cervical spondylotic myelopathy. BMC Musculoskelet Disord. 2015;16:290.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHofsetter CP, Kesavabhotla K, Bookvar JA. Zero \u0026ndash; profile anchored spaer reduces rate of dysphagia compared with acdf with anterior plating. J Spinal Disord Tech. 2015;28:284\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSong KJ, Taghavi CE, Lee KB, Song JH, Eun JP. The efcacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine. 2009;34(26):2886\u0026ndash;92\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine. 2002;27(22):2453\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNambiar M, Phan K, Cunningham JE, Yang Y, Turner PL, Mobbs R. Locking stand-alone cages versus anterior plate constructs in single-level fusion for degenerative cervical disease: a systematic review and meta-analysis. Eur Spine J. 2017;26(9):2258\u0026ndash;66\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJake M. McDonnell, Salma Youssef, Tayler D. Ross, Harry Marland, Luke Turley, Gr\u0026aacute;inne Cunniffe, Stacey Darwish, Joseph S. Butler. The efficacy of anchored stand-alone spacers in comparison to conventional cage and plate in anterior cervical discectomy and fusion surgery: A meta-analysis of randomised controlled trials for clinical and radiological outcomes. Brain and Spine. 2024;4:102748. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.bas.2024.102748\u003c/span\u003e\u003cspan address=\"10.1016/j.bas.2024.102748\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi Z, Zhao Y, Tang J, Ren D, Guo J, Wang H, et al. A comparison of a new zero-profle, stand-alone Fidji cervical cage and anterior cervical plate for single and multilevel ACDF: a minimum 2-year follow-up study. Eur Spine J. 2017;26(4):1129\u0026ndash;39\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVaishnav AS, Saville P, McAnany S, et al. Predictive factors of postoperative dysphagia in single-level anterior cervical discectomy and fusion. \u003cem\u003eSpine (Phila Pa 1976)\u003c/em\u003e 2019;44:E400\u0026ndash;E407. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/BRS.0000000000002865\u003c/span\u003e\u003cspan address=\"10.1097/BRS.0000000000002865\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZavras AG, Nolte MT, Sayari AJ, Singh K, Colman MW. Stand-alone cage versus anterior plating for 1-level and 2-level anterior cervical discectomy and fusion. Clin Spine Surg.2022;35(4):155\u0026ndash;165\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLan T, Lin JZ, Hu SY, et al. Comparison between Zero-profile spacer and plate with cage in the treatment of single level cervical spondylosis. \u003cem\u003eJ Back Musculoskelet Rehabil.\u003c/em\u003e 2018;31:299\u0026ndash;304. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3233/BMR-169708\u003c/span\u003e\u003cspan address=\"10.3233/BMR-169708\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim SJ, Kim SD. Anterior cervical discectomy and fusion using a double cylindrical cage versus an anterior cervical plating system with iliac crest autografts for the treatment of cervical degenerative disc disease. \u003cem\u003eJ Korean Neurosurg Soc.\u003c/em\u003e 2014;55:12\u0026ndash;17. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3340/jkns.2014.55.1.12\u003c/span\u003e\u003cspan address=\"10.3340/jkns.2014.55.1.12\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNemoto O, Kitada A, Naitou S, et al. Stand-alone anchored cage versus cage with plating for single-level anterior cervical discectomy and fusion: a prospective, randomized, controlled study with a 2-year follow-up. \u003cem\u003eEur J Orthop Surg Traumatol.\u003c/em\u003e 2015;25(Suppl 1):S127\u0026ndash;S134. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00590-014-1547-4\u003c/span\u003e\u003cspan address=\"10.1007/s00590-014-1547-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNoh SH, Park JY, Kuh SU, et al. Comparison of zero-profile anchored spacer versus plate-and-cage after 1-Level ACDF with complete uncinate process resection. \u003cem\u003eClin Spine Surg.\u003c/em\u003e 2021;34:176\u0026ndash;182. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/BSD.0000000000001129\u003c/span\u003e\u003cspan address=\"10.1097/BSD.0000000000001129\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHe S, Zhou Z, Lv N, et al. Comparison of clinical outcomes following anterior cervical discectomy and fusion with zero-profile anchored spacer-ROI-C-fixation and combined intervertebral cage and anterior cervical discectomy and fusion: a retrospective study from a single center. \u003cem\u003eMed Sci Monit.\u003c/em\u003e 2021;27:e931050. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.12659/MSM.931050\u003c/span\u003e\u003cspan address=\"10.12659/MSM.931050\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOh K, Lee CK, You NK, Kim SH, Cho KH: Radiologic changes of anterior cervical discectomy and fusion using allograft and plate augmentation: comparison of using fixed and variable type screw. Korean J Spine 10: 160\u0026ndash;164, 2013\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark SB, Chung CK, Lee SH, Yang HJ, Son YJ, Chung YS: The impact of menopause on bone fusion after the single-level anterior cervical discectomy and fusion. J Korean Neurosurg Soc 54: 496\u0026ndash;500, 2013\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePereira EA, Chari A, Hempenstall J, Leach JC, Chandran H, Cadoux-Hudson TA: Anterior cervical discectomy plus intervertebral polyetheretherketone cage fusion over three and four levels without plating is safe and effective long-term. J Clin Neurosci 20: 1250\u0026ndash;1255, 2013\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee YS, Kim YB, Park SW: Risk factors for postoperative subsidence of single-level anterior cervical discectomy and fusion: the significance of the preoperative cervical alignment. Spine (Phila Pa 1976) 39: 1280\u0026ndash;1287, 2014\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl-Tantawy A: Is it possible to eliminate the plate-related problems and still achieve satisfactory outcome after multilevel anterior cervical discectomy? Eur J Orthop Surg Traumatol 25(Suppl 1):135\u0026ndash;145, 2015\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSong KJ, Taghavi CE, Lee KB, Song JK, Eun JP: The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976) 34: 2886\u0026ndash;2892, 2009\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKast E, Derakhshani S, Bothmann M, Oberle J: Subsidence after anterior cervical inter-body fusion. A randomized prospective clinical trial. Neurosurg Rev 32: 207\u0026ndash;214; discussion 214, 2009\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eResnick DK, Trost GR: Use of ventral plates for cervical arthrodesis. Neurosurgery 60(1 Suppl 1):S112-S117, 2007\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDoo Kyung S, Wuk SD, Ho Sang K, et al. Comparative study 331 of clinical and radiological outcomes of a zero-profile device 332 concerning reduced postoperative Dysphagia after single level 333 anterior cervical discectomy and fusion. Journal of Korean 334 Neurosurgical Society 2014; 56: 103\u0026ndash;7\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen Y, Chen H, Cao P, et al. Anterior cervical interbody 336 fusion with the Zero-P spacer: mid-term results of two-level 337 fusion. European Spine Journal: Official Publication of the 338 European Spine Society, the European Spinal Deformity Soci- 339 ety, and the European Section of the Cervical Spine Research 340 Society 2015; 24: 1666-72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu D, Zhong D, Liu B, Li C, Zhu J. Can self- locking cages offer the same clinical outcomes as anterior cage-with-plate fixation for 3-level anterior cervical discectomy and fusion (ACDF) in mid-term follow-up. Med Sci Monit.2019;25:547\u0026ndash;557\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anterior cervical discectomy and fusion, PEEK cage, ACDF, anterior cervical plating, cervical radiculopathy, cervical myelopathy, standalone cage, fusion rate, dysphagia, cervical lordosis","lastPublishedDoi":"10.21203/rs.3.rs-7270486/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7270486/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAnterior cervical discectomy and fusion (ACDF) is a widely used procedure for treating cervical spondylotic myelopathy and radiculopathy. While anterior cervical plating (ACP) is the traditional method to ensure stability and fusion, it may be associated with increased dysphagia, adjacent segment degeneration, and hardware complications. Stand-alone polyetheretherketone (PEEK) cages offer a potential alternative with reduced operative morbidity. However, comparative evidence regarding their short-term clinical and radiological outcomes remains limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eCurrent ambispective cohort study encompassed 29 patients with cervical radiculopathy or radiculomyelopathy at C3-C7 levels. Group A (n\u0026thinsp;=\u0026thinsp;14) underwent ACDF with standalone PEEK cage, while Group B (n\u0026thinsp;=\u0026thinsp;15) underwent conventional ACDF with ACP. Clinical outcomes were determined by employing Visual Analog Scale (VAS) scores, Neck Pain Disability Index (NPDI), blood loss, operation time, Odom's criteria, and postoperative dysphagia. Radiological outcomes included fusion rates, cervical Cobb\u0026rsquo;s lordosis, and cage subsidence, assessed at 1, 3, and 6 months post-surgery.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBoth groups exhibited significant post-surgical improvements in NPDI and VAS scores (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with no notable intergroup differences (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Group A exhibited shorter operation times and less blood loss (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Dysphagia, fusion rates, and surgical outcomes were similar between the groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, Group A exhibited relatively greater cage subsidence, cervical lordosis, loss of disc height, as well as fused segment angle (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eACDF with stand-alone PEEK cages demonstrated clinical outcomes comparable to ACDF with ACP fixation but showed higher rates of postoperative complications, including loss of cervical lordosis and cage subsidence.\u003c/p\u003e","manuscriptTitle":"Anterior Cervical Discectomy and Fusion with Polyetheretherketone Cage or Anterior Cervical Plate: A Comparative Evaluation of Short-term Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-22 10:27:25","doi":"10.21203/rs.3.rs-7270486/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b9c4a6d-c1a7-4697-8c92-aff2aa7a488b","owner":[],"postedDate":"August 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T21:38:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-22 10:27:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7270486","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7270486","identity":"rs-7270486","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}