Zero-Profile Stand-Alone Cages Versus Traditional Cage-and-Plate Constructs in Single and Multi-Level Anterior...

Area of Science:

• Spine Surgery
• Orthopedic Surgery
• Neurosurgery

Background:

• Anterior cervical discectomy and fusion (ACDF) utilizes stand-alone (SA) and anterior cage-and-plate (ACP) devices.
• Existing studies on ACDF outcomes lack propensity matching and comprehensive patient-reported outcome measures (PROMs).
• Variability in fusion assessment methods complicates comparisons between SA and ACP.

Purpose of the Study:

• To compare fusion rates between propensity-matched single- and multi-level SA versus ACP in ACDF.
• To evaluate differences in sagittal alignment, perioperative outcomes, and PROMs between SA and ACP.
• To utilize a fusion assessment method validated by intraoperative motion testing during revision surgery.

Main Methods:

• A propensity score-matched study included patients over 18 years undergoing primary ACDF (2:1 matching).
• Fusion was assessed using 1-year CT scans and flexion/extension radiographs with validated methods.
• Anterior-lower-order displacement (ALOD), sagittal alignment, PROMs, operative time, blood loss, and complications were analyzed.

Main Results:

• No significant differences in fusion rates were observed between SA and ACP overall or by surgical level.
• Comparable sagittal alignment, ALOD, and PROMs (NDI, SF-12 PCS, VAS neck/arm) were found between the groups.
• ACP cohort experienced greater operative time and blood loss; complication and dysphagia rates were similar.

Conclusions:

• Fusion rates, PROMs, radiographic outcomes, and complication rates are comparable between SA and ACP in ACDF.
• Both SA and ACP are effective for single and multi-level ACDF, with similar safety profiles.
• The choice between SA and ACP may depend on specific surgical factors rather than overall efficacy.