Is outcome of Anterior Cervical Discectomy for Cervical Radiculopathy influenced by securing the Intervertebral Cage?

Anterior Cervical Discectomy and Fusion (ACDF) for cervical radiculopathy is commonly performed with a cage and plate in the United States, whereas in Europe, standalone cages are frequently used instead. Knowledge about difference in clinical outcome is scarce. Are there differences in clinical outcomes in patients undergoing ACDF using a cage with an anterior plate, a cage with integrated screws, or a standalone cage? 570 patients with cervical radiculopathy were included: 414 received a cage with plate (US), 54 received cages with integrated screws (US) and 102 received a standalone cage (86% Netherlands). The clinical outcomes Visual Analogue Scale arm and neck pain, and pain interference were assessed at baseline, 3, 6, 12 and 24 months after inclusion, and analysed using linear mixed-effects models. Furthermore, the Minimal Clinical Important Difference was assessed and to explore individual patient-level outcome, cut-off values for clinical success were utilized. Baseline clinical parameters were comparable in the three groups. Linear mixed-effects models revealed no statistically significant differences in clinical outcome over time. However, dichotomized clinical success rates for neck pain were significantly higher in the standalone group (62.9% at 6 months, 79.3% at 12 months, 85.7% at 24 months), compared to the cage with plate group (59.5%, 61.2%, 58.9%) and the integrated screws group, which showed more variability (58.3%, 26.7%, 44.4%). No substantial differences were observed at the group mean-level, however, the standalone cage group demonstrated higher individual-level success-rates, particularly regarding neck pain. • ACDF cage fixation strategies vary between the United States and Northern Europe. • Mixed-effects models demonstrate comparable mean improvements in clinical outcomes. • Dichotomized success analyses show higher neck pain success with standalone cages