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Background <p>Anterior cervical discectomy and fusion (ACDF) is an established procedure for treating degenerative cervical spine disease. While plate systems have been employed to optimize stability, the use of stand-alone cages was subsequently promoted to reduce plate-associated complications. The optimal stabilization strategy remains debated. This study compared clinical and radiological outcomes between both techniques.</p> Methods <p>This retrospective two-center analysis examined 238 patients who underwent single-level ACDF for degenerative indications between 2012 and 2023. Stand-alone cages were used in 176 patients (73.9%) and cage-plate constructs in 62 patients (26.1%). Primary endpoints included cage subsidence (CS), pseudarthrosis, reoperations and clinical outcomes at 3 and 12 months postoperatively. Secondary endpoints comprised radiological parameters encompassing segmental (SL) and cervical lordosis (CL), as well as intervertebral height measurements. Multivariable logistic regression was adjusted for baseline differences.</p> Results <p>Cage-plate patients were older (mean difference 7 years, <i>p</i> &lt; 0.001), had higher ASA grades (<i>p</i> = 0.017), and more frequently presented with central stenosis (<i>p</i> = 0.001) and myelopathy (<i>p</i> = 0.006). Operative time was 26&#xa0;min longer in the plate group (<i>p</i> &lt; 0.001) while blood loss and perioperative complications were comparable. At 3 months, the stand-alone group showed significantly higher CS rates (31.8% vs. 16.1%; adjusted odds ratio [aOR] 2.54, 95% CI 1.13–5.71, <i>p</i> = 0.024), and had lower odds of favorable clinical outcome (aOR 0.23, 95% CI 0.08–0.72, <i>p</i> = 0.011). At 12 months, pseudarthrosis was markedly higher in the stand-alone group (26.7% vs. 3.2%; aOR 9.23, 95% CI 2.13–39.9, <i>p</i> = 0.003). The cage-plate group demonstrated superior preservation of SL (mean difference (MD) 1.7°; <i>p</i> = 0.036), CL (MD 5.9°; <i>p</i> &lt; 0.001), and intervertebral height (all <i>p</i> &lt; 0.01). Excellent/good outcomes were more frequent in the plate group (54.8% vs. 40.3%; <i>p</i> = 0.046), though this was short of significance after multivariable adjustment (aOR 0.48, 95% CI 0.20–1.14, <i>p</i> = 0.097).</p> Conclusion <p>Additional plating in single-level ACDF was associated with reduced risk of both cage subsidence and pseudarthrosis and improved sagittal alignment at the cost of moderately increased operative time. These findings support preferential use of cage-plate constructs, particularly in elderly patients with central stenosis, myelopathy, or risk factors for pseudarthrosis.</p>

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Single-level anterior cervical discectomy and fusion for degenerative disc disease: a retrospective, two-center comparative analysis of stand-alone cage versus cage-plate constructs

  • 期刊论文

  • 发表日期：

    2026年6月22日

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  • Raphael Gmeiner,
  • Vanessa Woerz,
  • Athina Firtinidou,
  • Felix Corr,
  • Vincens Kälin,
  • Felix C. Stengel,
  • Linda Bättig,
  • Daniele Gianoli,
  • Laurin Feuerstein,
  • Faizan Kareem,
  • Silvio A. Heinig,
  • Matthias Demetz,
  • Anna Koller,
  • Anto Abramovic,
  • Selina De Razza,
  • Sara Lener,
  • Claudius Thomé,
  • Benjamin Martens,
  • Martin N. Stienen

摘要

Background

Anterior cervical discectomy and fusion (ACDF) is an established procedure for treating degenerative cervical spine disease. While plate systems have been employed to optimize stability, the use of stand-alone cages was subsequently promoted to reduce plate-associated complications. The optimal stabilization strategy remains debated. This study compared clinical and radiological outcomes between both techniques.

Methods

This retrospective two-center analysis examined 238 patients who underwent single-level ACDF for degenerative indications between 2012 and 2023. Stand-alone cages were used in 176 patients (73.9%) and cage-plate constructs in 62 patients (26.1%). Primary endpoints included cage subsidence (CS), pseudarthrosis, reoperations and clinical outcomes at 3 and 12 months postoperatively. Secondary endpoints comprised radiological parameters encompassing segmental (SL) and cervical lordosis (CL), as well as intervertebral height measurements. Multivariable logistic regression was adjusted for baseline differences.

Results

Cage-plate patients were older (mean difference 7 years, p < 0.001), had higher ASA grades (p = 0.017), and more frequently presented with central stenosis (p = 0.001) and myelopathy (p = 0.006). Operative time was 26 min longer in the plate group (p < 0.001) while blood loss and perioperative complications were comparable. At 3 months, the stand-alone group showed significantly higher CS rates (31.8% vs. 16.1%; adjusted odds ratio [aOR] 2.54, 95% CI 1.13–5.71, p = 0.024), and had lower odds of favorable clinical outcome (aOR 0.23, 95% CI 0.08–0.72, p = 0.011). At 12 months, pseudarthrosis was markedly higher in the stand-alone group (26.7% vs. 3.2%; aOR 9.23, 95% CI 2.13–39.9, p = 0.003). The cage-plate group demonstrated superior preservation of SL (mean difference (MD) 1.7°; p = 0.036), CL (MD 5.9°; p < 0.001), and intervertebral height (all p < 0.01). Excellent/good outcomes were more frequent in the plate group (54.8% vs. 40.3%; p = 0.046), though this was short of significance after multivariable adjustment (aOR 0.48, 95% CI 0.20–1.14, p = 0.097).

Conclusion

Additional plating in single-level ACDF was associated with reduced risk of both cage subsidence and pseudarthrosis and improved sagittal alignment at the cost of moderately increased operative time. These findings support preferential use of cage-plate constructs, particularly in elderly patients with central stenosis, myelopathy, or risk factors for pseudarthrosis.