Cervical fusion techniques unmasked: plating vs. cage-only

Abstract

AIM: To compare the effect of fusion with anterior plating and cage (PLATE) versus cage-only (CAGE-O) technique on postoperative cervical sagittal alignment parameters, clinical outcome, and complication profiles after two-level anterior cervical discectomy and fusion (ACDF). MATERIAL and METHODS: Clinical and radiological data of 42 patients who underwent two-level ACDF with either cage-only or anterior plating were retrospectively analyzed. Sagittal alignment parameters, including cervical lordosis, C0-C2 angle, T1 slope, and cervical sagittal vertical axis (cSVA), were evaluated preoperatively and postoperatively. Clinical outcomes were analyzed using the visual analog scale (VAS) and Neck Disability Index (NDI) scores. RESULTS: Both groups showed significant clinical improvement in VAS and NDI scores over a 2-year follow-up period. Postoperatively, the CAGE-O group exhibited a significant increase in T1 slope and C0-C2 angles, whereas the PLATE group did not. Cervical lordosis and cSVA values showed no significant change postoperatively in both groups. Complication rates were similar between both groups. CONCLUSION: Both anterior plating and cage-only techniques in two-level ACDF demonstrated comparable outcomes in terms of sagittal alignment, clinical improvement, and complication rates. The decision to utilize anterior plating should be based on individual patient factors and surgeon preference rather than differences in outcomes. © 2025 Elsevier B.V., All rights reserved.