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Comparative Study
. 2025 Mar 10;20(1):256.
doi: 10.1186/s13018-025-05654-x.

A retrospective comparative analysis of anterior cervical discectomy and fusion using stand-alone titanium cage versus cage and plate fixation in two-level cervical disc herniation

Cem Sever  1 , Bekir Eray Kilinc  2 , Ahmet Onur Akpolat  3 , Tayfun Bozkaya  3 , Akif Kurtan  4 , Abdulhamit Misir  5
Affiliations
Comparative Study

A retrospective comparative analysis of anterior cervical discectomy and fusion using stand-alone titanium cage versus cage and plate fixation in two-level cervical disc herniation

Cem Sever et al. J Orthop Surg Res. .

Abstract

Background: This study aims to compare the outcomes of two-level anterior cervical discectomy and fusion (ACDF) procedures using stand-alone cages versus cage and plate fixation in patients diagnosed with cervical disc herniation (CDH).

Materials and methods: This retrospective analysis included 60 patients who underwent two-level ACDF procedures. Patients were divided into two groups: one treated with stand-alone cages and the other with cage and plate fixation. Data on surgical duration, blood loss, fusion stability, and complication rates were collected. Clinical outcomes, including neck pain and functional status, were assessed using standard scoring systems.

Results: Plate fixation provided superior fusion stability but was associated with longer surgery durations, higher intraoperative blood loss, and increased complication rates. Stand-alone cages reduced intraoperative trauma but demonstrated higher subsidence rates and prolonged fusion times. Both techniques resulted in significant improvements in neck pain and disability scores.

Discussion: While both approaches are effective for managing cervical disc herniation, each has distinct advantages and limitations. Surgical technique selection should be individualized, considering patient-specific anatomical factors, functional demands, and the risk-benefit profile of each approach.

Keywords: Anterior cervical discectomy; Cage and plate fixation; Cervical disc herniation; Cervical discectomy; Hernia grading system; Stand-alone cage fixation.

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Conflict of interest statement

Declarations. Ethical approval: IRB was subsequently obtained (decision number: KSYLEAH-KAEK 2024/81). Informed consent: Informed consent was obtained from patients. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Demineralized filled cages
Fig. 2
Fig. 2
Plate usage for integrated locking system to prevent screw pull-out
Fig. 3
Fig. 3
Cervical level distribution of the groups
Fig. 4
Fig. 4
Hernia Grading System (HGS) Distribution of the patients in Group 1 and Group 2
Fig. 5
Fig. 5
Long-term changes in pain and functional scores (VAS-Neck Scores)
Fig. 6
Fig. 6
Long-term changes in pain and functional scores (VAS-Arm Scores)
Fig. 7
Fig. 7
Long-term changes in pain and functional scores (NDI Scores)
See this image and copyright information in PMC

References

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