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J Spine Surg. 2017 Dec;3(4):596-600. doi: 10.21037/jss.2017.11.06.

A radiographic follow-up study of stand-alone-cage and graft-plate constructs for single-level anterior cervical discectomy and fusion.

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Department of Orthopedic Surgery, Waikato Hospital, Hamilton, New Zealand.
Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.
Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, NY, USA.
Loma Linda University, School of Medicine, Loma Linda, CA, USA.



Anterior cervical discectomy and fusion (ACDF) may be performed using an interbody cage or graft with an anterior plate or with a stand-alone (SA) interbody device without the anterior plate. The pros and cons of each vary. This study examined the radiographic outcome of the two techniques with a focus on implant subsidence.


A retrospective review of cases of singe level ACDF by a single surgeon was undertaken. Medical and radiographic records were reviewed to determine subsidence, pre- and post-operative segmental and total lordosis in cohorts of both stand-alone and graft-and-plate constructs.


The post-operative radiographs of 35 patients with a SA cage were compared with 41 patients with an allograft block and anterior plate (graft and plate; GP). There was no significant difference in overall subsidence between the two groups although there was a trend toward less clinically significant subsidence (2 mm) in the SA group. For single level ACDF, a SA device appears to be comparable in terms of undesired subsidence.


Further studies with different implants and materials may offer further insight.


Anterior cervical discectomy and fusion (ACDF); allograft; cervical spondylosis; stand-alone cage (SA cage)

Conflict of interest statement

Conflicts of Interest: Dr. Baker reports personal fees from 3D4Medical, outside the submitted work, other authors have no conflicts of interest to declare.

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