European Spine Journal

, Volume 28, Issue 1, pp 199–208 | Cite as

Clinical outcomes of locking stand-alone cage versus anterior plate construct in two-level anterior cervical discectomy and fusion: a systematic review and meta-analysis

  • Victor M. LuEmail author
  • Ralph J. Mobbs
  • Bernard Fang
  • Kevin Phan
Review Article



Two-level cervical degenerative disc disease (cDDD) can be effectively treated by anterior cervical discectomy and fusion (ACDF) similarly to single-level cDDD. Traditionally an anterior plate construct (APC) approach has been utilized, but ACDF without plate with a locking stand-alone cage (LSC) approach has emerged as an alternative option. The aim of this study was to compare the clinical outcome of LSC and APC in contiguous two-level ACDF used to treat cDDD the current literature.


Searches of seven electronic databases from inception to March 2018 were conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Extracted data were analysed using meta-analysis of proportions.


The nine observational studies that satisfied all criteria described a pooled cohort of 687 contiguous two-level cDDD cases managed by ACDF, with 302 (44%) and 385 (56%) managed by LSC and APC approaches, respectively. When compared with APC, LSC was associated with significantly increased subsidence likelihood (OR 2.75; p < 0.001), greater disc height (MD 0.60 mm; p = 0.04) and reduced cervical lordosis (MD − 2.52°; p = 0.04) at last follow-up. Operative outcomes, fusion rates, functional scores and postoperative dysphagia rates were comparable.


Although significant radiological differences were most evident, the comparability between LSC and APC in contiguous two-level ACDF with respect to all other clinical outcomes does not implicate one approach as clearly superior to the other in two-level ACDF. Larger, randomized studies with longer follow-up are required to delineate outcomes further to validate the findings of this study.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Stand-alone Zero-profile Plate Anterior cervical discectomy and fusion Two-level 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Supplementary material

586_2018_5811_MOESM1_ESM.pptx (152 kb)
Supplementary material 1 (PPTX 152 kb)
586_2018_5811_MOESM2_ESM.docx (141 kb)
Supplementary material 2 (DOCX 141 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Victor M. Lu
    • 1
    Email author
  • Ralph J. Mobbs
    • 1
    • 2
  • Bernard Fang
    • 3
  • Kevin Phan
    • 1
    • 2
  1. 1.Prince of Wales Clinical SchoolUniversity of New South WalesSydneyAustralia
  2. 2.NeuroSpine Surgery Research Group (NSURG)Prince of Wales Private HospitalSydneyAustralia
  3. 3.Faculty of Medicine, Sydney Medical SchoolUniversity of SydneySydneyAustralia

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