Anterior cervical discectomy and fusion (ACDF) with and without plating: A comparison of radiological and clinical outcomes

Treatment for degenerative disc disease of the cervical spine primarily aims to decompress neural structures and preserve the former height of the disc space and foramina. Popular methods include anterior cervical discectomy and fusion (ACDF) using cages with plates or without plates (standalone cages). However, it is still debatable whether a plate is necessary for enhanced treatment outcomes. This paper reviews current literature reports, adding insights from the authors' experience. A literature search was performed with keywords related to ACDF with or without cervical plating. We analyzed the titles and abstracts to identify all potentially relevant studies. Out of these, a total of 28 original research and 5 systematic reviews/meta-analyses met our inclusion criteria. The success of surgery for cervical disc disease depends fundamentally on the appropriate decompression of neural structures. This is the main determinant of postoperative clinical improvement measured according to scales capturing changes in pain intensity and quality of life. An ideal replacement for natural components of the human body does not exist, even though more and more refined solutions are developed every year. A comparison of treatment outcomes using non-plated (standalone) cages and cage + plate systems requires separate analysis of radiological and clinical outcomes. Both methods have their advantages and disadvantages. Radiological outcomes are slightly better with cage + plate systems, and clinical outcomes are comparable.