Is outcome of anterior cervical discectomy for cervical radiculopathy influenced by securing the intervertebral cage?

Introduction: 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. Research question: 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? Methods: 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. Results: 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%). Discussion and conclusion: 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.