# The Effectiveness of Zero-Profile Cages Versus Traditional Bone Graft Placement With Plate Fixation in Anterior Cervical Discectomy and Fusion for Single- and Two-Level Cervical Prolapsed Intervertebral Discs: A Comparative Prospective Study

## TL;DR

This study compares zero-profile cages and traditional bone grafts in cervical spine surgery, finding similar outcomes but fewer re-operations with cages.

## Contribution

The study provides new comparative clinical and radiological data on zero-profile cages versus traditional bone grafts in cervical fusion.

## Key findings

- Both zero-profile cages and bone grafts showed significant improvement in disability and pain scores.
- Fusion rates were comparable between the two groups.
- Zero-profile cages had a lower re-operation rate than traditional bone grafts.

## Abstract

Introduction

Anterior cervical discectomy and fusion (ACDF) is considered the gold standard procedure for fixation of cervical disc degenerative disease. However, the optimal construct remains debated between zero-profile cages and bone graft with anterior plate fixation.

Objective

This study aims to evaluate the clinical and radiological outcomes of zero-profile cages with standard bone graft and plate fixation in single- and two-level cervical prolapsed intervertebral disc surgery.

Methods

This prospective observational study was conducted at the Neurosurgery department after enrolling patients aged 18-70 years with symptomatic cervical disc disease refractory to ≥6 weeks of conservative management who underwent ACDF either with a zero-profile titanium cage (Group A) or with autologous iliac crest bone graft and anterior cervical plate fixation (Group B). Standard surgical technique (Smith-Robinson approach) and uniform postoperative protocols were used. Clinical outcomes (Neck Disability Index (NDI) and Visual Analogue Scale (VAS)) and radiological fusion were assessed preoperatively and at 12 months.

Results

A total of 103 patients were included in the study (Group A: 57; Group B: 46). At 12 months, significant improvement in NDI was observed in both groups (Group A: 21/57 (36.8%) had improved scores vs. 3/57 (5.3%) worsened; Group B: 17/46 (37.0%) improved vs. 3/46 (6.5%) worsened; both p < 0.01). VAS scores also improved significantly (Group A: 23/57 (40.4%) improved; Group B: 18/46 (39.1%); p < 0.01). Fusion was achieved in 51/57 (89.5%) in Group A and 39/46 (84.8%) in Group B (p = 0.301). Dysphagia with plate fixation was 3/46 (6.5%) and with zero-profile cages was 4/57 (7.0%). No significant difference in re-operations was noted.

Conclusion

Both techniques demonstrated comparable functional outcomes and fusion rates. However, zero-profile cages were associated with a significantly lower re-operation rate compared with bone graft and plate fixation, indicating a potential advantage in reducing revision surgery.