Stand-alone cage versus cage–plate fixation in anterior cervical discectomy and fusion for cervical myeloradiculopathy: A retrospective comparative study of clinical and radiological outcomes

Anterior cervical discectomy and fusion (ACDF) is the standard surgical treatment for cervical myeloradiculopathy. The choice between stand-alone cage (SAC) and cage-and-plate (CAP) constructs remains controversial, with concerns regarding perioperative morbidity and biomechanical stability. To compare clinical, radiological, and perioperative outcomes between SAC and CAP constructs in patients undergoing ACDF. A retrospective comparative study was conducted on 60 patients (30 SAC, 30 CAP) who underwent ACDF at a tertiary care centre, with a minimum follow-up of 12 months. Clinical outcomes were assessed using Japanese Orthopaedic Association (JOA) score, Visual Analogue Scale (VAS), and Neck Disability Index (NDI). Radiological outcomes included fusion rate, subsidence, and cervical lordosis. Statistical analysis was performed using independent t-test and chi-square test, with significance set at p < 0.05. The SAC group demonstrated significantly shorter operative time (102.3 ± 14.6 vs 120.8 ± 16.5 minutes, p = 0.001), lower blood loss (80 ± 22 vs 125 ± 30 mL, p < 0.001), and reduced hospital stay (2.8 ± 0.9 vs 4.1 ± 1.3 days, p < 0.001). Fusion rates were comparable (96.7% vs 100%, p = 0.31). However, SAC was associated with higher subsidence (16.7% vs 3.3%, p = 0.04) and less improvement in cervical lordosis (+2.0° vs +3.6°, p = 0.02). Clinical outcomes (JOA, VAS, NDI) improved significantly in both groups with no intergroup difference. Stand-alone cage constructs provide comparable clinical outcomes to cage–plate fixation in ACDF, with advantages of reduced operative morbidity and shorter hospitalization. However, they are associated with higher subsidence and reduced lordotic correction, which should be considered in surgical decision-making.