Background <p>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).</p> Materials and methods <p>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.</p> Results <p>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.</p> Discussion <p>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.</p>