Screw-Integrated vs Traditional Cervical Cages in ACDF for Degenerative Disc Disease

Cervical degenerative disc disease (CDDD) is a common degenerative spinal disorder and a well-recognized cause of neck pain, cervical radiculopathy, and myelopathy. In patients who fail to respond to conservative treatment, anterior cervical discectomy and fusion (ACDF) is considered the gold standard surgical procedure for single-level disease, as originally described and validated in several classical and long-term studies. The main objectives of ACDF include adequate neural decompression, restoration of disc height, maintenance of cervical alignment, and achievement of solid interbody fusion.

Various interbody fusion devices have been developed to improve fusion outcomes. The traditional standalone cervical cage has demonstrated acceptable clinical results; however, several authors have reported potential complications such as cage subsidence, segmental kyphosis, and delayed or incomplete fusion. To overcome these limitations, cervical cages with integrated screw fixation and zero-profile devices have been introduced to provide immediate segmental stability and reduce micromotion at the fusion site, as supported by biomechanical and clinical evidence.

Available data from the literature show inconsistent results regarding the superiority of screw-integrated cages compared to traditional cages in single-level ACDF. While some studies reported improved radiological stability, better maintenance of cervical lordosis, and higher fusion rates with screw-fixed cages, other studies demonstrated comparable clinical and radiological outcomes between both techniques. Currently, the choice of fusion device is largely based on surgeon preference rather than definitive evidence. Therefore, the rationale of this research is to conduct a comparative evaluation of cervical cages with screws versus traditional cervical cages in ACDF, aiming to clarify their impact on fusion, alignment, and clinical outcomes

Inclusion criteria

• Patients aged above 18 years old.
• Clinical diagnosis of cervical degenerative disc disease (CDDD).
• Single or double level cervical degenerative disc disease (CDDD) confirmed by MRI
• Failure of conservative treatment for at least 6 weeks.
• Patients indicated for Anterior Cervical Discectomy and Fusion (ACDF).
• Availability of complete preoperative and postoperative clinical and radiological data.
• Willing and able to provide informed consent.

Exclusion criteria

• Previous cervical spine surgery.
• Mutli-level (more than double level) cervical degenerative disc disease (CDDD).
• Significant cervical instability requiring additional posterior fixation
• Cervical trauma, fracture, or spinal infection.
• Cervical tumors or inflammatory spinal disease.
• Severe cervical deformity (fixed kyphosis)
• Osteoporosis or metabolic bone disease.
• Pregnancy
• Psychiatric illness or substance abuse that would compromise follow-up