Comparison of Anterior Cervical Discectomy and Fusion using a Novel 3D-Printed Porous Titanium Cage versus Conventional Allograft Bone Block with Plate and Screw System: A Propensity-Matched Cohort Study

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) with plate and screw fixation is a standard treatment for degenerative cervical disc disease. However, the advent of 3D-printed porous titanium cages (3D-PTCs) has prompted ongoing attempts to integrate this technology into ACDF procedures. OBJECTIVE: To compare the 2-year clinical and radiologic outcomes of single-level ACDF using a stand-alone 3D-PTC versus conventional ACDF with allograft and anterior plating. METHODS AND MATERIALS: In this retrospective, propensity-matched cohort study, 30 patients per group were analyzed. Clinical outcomes included visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and dysphagia. Radiologic outcomes were fusion rate, segmental range of motion, and subsidence. Intraoperative blood loss, drainage, and fluoroscopy counts were recorded. RESULTS: Neck pain improvement was greater in the 3D-PTC group at all follow-ups (all P < 0.05). Dysphagia was less frequent at day 3 (10 vs. 19, P = 0.020) and 1 month (3 vs. 10, P = 0.028). Prevertebral swelling was smaller at day 3 (11.53 vs. 18.37 mm, P < 0.001), 1 month (P = 0.001), and 3 months (P = 0.007). Fluoroscopy counts were lower (5.7 vs. 7.9, P = 0.031). Fusion at 2 years was 100% in both groups, with similar subsidence (33.3% vs. 30.0%, P = 0.781). No device-related complications occurred. CONCLUSIONS: Stand-alone 3D-PTC ACDF achieved comparable fusion and safety to conventional plated ACDF, with reduced dysphagia, swelling, and fluoroscopy use, and greater neck pain relief, supporting its viability as an alternative technique.