Comparison of Anterior Cervical Discectomy and Fusion With a Stand-Alone Interbody Cage Versus a Conventional Cage-Plate Technique: A Systematic Review and Meta-Analysis

Abstract

Study design: Systematic review and meta-analysis.

Objective: Compare the clinical and radiographic outcomes of anterior cervical discectomy and fusion (ACDF) with a stand-alone interbody cage versus a conventional cage and anterior cervical plate technique.

Methods: A systematic Medline search was conducted using PubMed, EMBASE, and Cochrane Library Database of Systematic Reviews. Search terms included "anterior cervical discectomy and fusion," "cage," and "bone plates," or variations thereof. Only studies involving a direct comparison of ACDF with a stand-alone cage versus a cage and plate were included. From the selected studies, we extracted data on patient demographics, comorbidities, surgical risk factors, and pre- and postoperative radiographic findings. A meta-analysis was performed on all outcome measures. The quality of each study was assessed using the Downs and Black checklist.

Results: Nineteen studies met the inclusion and exclusion criteria. Patients who underwent ACDF with a cage-only technique had significantly lower rates of postoperative dysphagia and adjacent segment disease compared with patients who underwent ACDF with a cage-plate technique. However, patients who underwent ACDF with a cage-plate technique had better radiographic outcomes with significantly less subsidence and better restoration of cervical lordosis. There were no other significant differences in outcomes or postoperative complications.

Conclusions: ACDF with a cage-only technique appears to have better clinical outcomes than the cage-plate technique, despite radiographic findings of increased rates of subsidence and less restoration of cervical lordosis. Future randomized controlled trials with longer term follow-up are needed to confirm the findings of this meta-analysis.

Keywords: ACDF; cervical; degenerative disc disease; discectomy; fixation.

Figure 1.

Flowsheet illustrating study selection for this systematic review and meta-analysis.

Figure 2.

Baseline patient demographics and comorbidity variables.

Figure 3.

Forest plot of differences in dysphagia within and beyond 3 months of anterior cervical discectomy and fusion (ACDF) between the cage-only (Cage) and cage-plate (CP) groups. The cage-only group experienced significantly less dysphagia than the cage-plate group both within and beyond 3 months of surgery.

Figure 4.

Forest plot of differences in estimated blood loss between the cage-only (Cage) and cage-plate (CP) groups. The cage-only group had statistically significant lower blood than the cage-plate group.

Figure 5.

Forest plot of differences in adjacent segment disease (ASD) between the cage-only (Cage) and cage-plate (CP) groups. The cage-only group had significantly decreased risk of ASD than the cage-plate group.

Figure 6.

Forest plot of differences in fusion rate between the cage-only (Cage) and cage-plate (CP) groups. There was no significant difference in fusion rate between the 2 groups.