Comparison of cage with plate versus tricortical iliac crest graft with plate fixation in anterior cervical discectomy and fusion: A retrospective study

Objectives: Anterior cervical discectomy and fusion (ACDF) is a widely accepted procedure for the management of degenerative cervical disc disease. Different fusion techniques, including cage with plate fixation and tricortical iliac crest graft (ICG) with plate fixation, are employed, but their comparative effectiveness remains debated. The present study aimed to compare clinical outcomes, fusion rates, and complications between these two techniques. Material and Methods: This retrospective study was conducted between 2015 and 2023 and included 194 patients with cervical disc disease who underwent ACDF (100 with cage and plate fixation, 94 with tricortical ICG and plate fixation). Patients were assessed for fusion, pain relief, functional outcomes (Odom’s criteria, Visual Analog Scale [VAS]), and complications. Results: The mean age was 50.2 ± 10.1 years in the cage group and 53.4 ± 6.5 years in the graft group, with a male predominance in both cohorts. Solid radiological fusion was achieved in 100% of patients in both groups at final follow-up. According to Odom’s criteria, excellent-to-good outcomes were observed in 83% of the cage group and 87% of the graft group ( P = 0.001). The mean post-operative VAS was 45.32 ± 10.2 in the cage group and 41.5 ± 11.1 in the graft group ( P = 0.034). Complications included dysphagia (6 in cage vs. 5 in graft), cage subsidence (2 cases), infection (4 in cage vs. 1 in graft), and donor-site pain in 20 graft patients. Conclusion: Both cages with plate fixation and tricortical ICG with plate fixation in ACDF provided high fusion rates and favorable functional outcomes, with no significant difference in overall efficacy. However, cage use reduced donor-site morbidity, whereas autograft provided robust biological fusion. The choice of technique should be individualized based on patient factors and surgeon preference.