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Standalone cage versus anchored cage for anterior cervical discectomy and fusion: a comparative analysis of clinical and radiological outcomes

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The use of standalone cages (SAC) and anchored cages (AC) in anterior cervical discectomy and fusion surgery (ACDF) has shown advantage of reduced operative time and lower incidence of dysphagia. However, there is limited literature available comparing the clinical and radiological outcomes of SAC and AC.


We conducted a prospective study for patients undergoing ACDF for cervical radiculopathy or myelopathy. Patient were classified based on the cage used into SAC group and the AC group. Clinical outcomes were assessed using the modified Japanese Orthopedic Association (mJOA) for myelopathy and Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for radiculopathy. Dysphagia was graded as per Bazaz score. Radiologically, global cervical lordosis, segmental lordosis, cage subsidence, and migration were assessed.


We analyzed 31 patients in each group with a minimum two year follow-up. The mean VAS improved from 7.9 to 4.56, mean NDI score improved from 27.6 to 19.8, and mean mJOA improved from 10.8 to 11.7 which were statistically significant (p < 0.05); however, no significant difference was noted between the SAC and AC groups. Mean global lordosis improved from 14.4 to 20.3° and mean segmental lordosis improved from 6 to 10.1° at six months and plateaued to 6.9° at final follow up without any significant difference between the groups. The subsidence was statistically more in 12.9% (4/31) in SAC than 6.4% (2/31) in AC.


AC showed of lower rates of subsidence while both SAC and AC had comparable clinical outcomes and radiological alignment outcomes.

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Authors and Affiliations



All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Dr Siddharth Aiyer, Dr Shailesh Hadgaonkar, and Dr Ajay Kothari. The first draft of the manuscript was written by Dr Niharika Virkar and Dr Pramod Bhilare and critical revision was done by Dr Siddharth Aiyer. Project administration was carried out by Dr Parag Sancheti. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Siddharth Aiyer.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Sancheti Institute for Orthopaedics and Rehabilitation Institute Ethics Committee (Date: 2/11/2019 /No:IEC-SIOR/Agenda 058).

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1 and 2.

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Virkar, N., Bhilare, P., Hadgaonkar, S. et al. Standalone cage versus anchored cage for anterior cervical discectomy and fusion: a comparative analysis of clinical and radiological outcomes. International Orthopaedics (SICOT) 46, 2339–2345 (2022).

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