The Effectiveness of Zero-Profile Cages Versus Traditional Bone Graft Placement With Plate Fixation in Anterior Cervical Discectomy and Fusion for Single- and Two-Level Cervical Prolapsed Intervertebral Discs: A Comparative Prospective Study

Introduction Anterior cervical discectomy and fusion (ACDF) is considered the gold standard procedure for fixation of cervical disc degenerative disease. However, the optimal construct remains debated between zero-profile cages and bone graft with anterior plate fixation. Objective This study aims to evaluate the clinical and radiological outcomes of zero-profile cages with standard bone graft and plate fixation in single- and two-level cervical prolapsed intervertebral disc surgery. Methods This prospective observational study was conducted at the Neurosurgery department after enrolling patients aged 18-70 years with symptomatic cervical disc disease refractory to ≥6 weeks of conservative management who underwent ACDF either with a zero-profile titanium cage (Group A) or with autologous iliac crest bone graft and anterior cervical plate fixation (Group B). Standard surgical technique (Smith-Robinson approach) and uniform postoperative protocols were used. Clinical outcomes (Neck Disability Index (NDI) and Visual Analogue Scale (VAS)) and radiological fusion were assessed preoperatively and at 12 months. Results A total of 103 patients were included in the study (Group A: 57; Group B: 46). At 12 months, significant improvement in NDI was observed in both groups (Group A: 21/57 (36.8%) had improved scores vs. 3/57 (5.3%) worsened; Group B: 17/46 (37.0%) improved vs. 3/46 (6.5%) worsened; both p < 0.01). VAS scores also improved significantly (Group A: 23/57 (40.4%) improved; Group B: 18/46 (39.1%); p < 0.01). Fusion was achieved in 51/57 (89.5%) in Group A and 39/46 (84.8%) in Group B (p = 0.301). Dysphagia with plate fixation was 3/46 (6.5%) and with zero-profile cages was 4/57 (7.0%). No significant difference in re-operations was noted. Conclusion Both techniques demonstrated comparable functional outcomes and fusion rates. However, zero-profile cages were associated with a significantly lower re-operation rate compared with bone graft and plate fixation, indicating a potential advantage in reducing revision surgery.