For a study, researchers sought to compare the perioperative and radiographic outcomes of stand-alone and anterior plating 1 and 2-level anterior cervical discectomy with fusion (ACDF). Patients with 1- to 2-level degenerative disease were enrolled prospectively and randomly assigned to 1 of 2 treatment arms: PLATE or CAGE reconstruction. Patients were followed for at least a year after surgery. The primary goals were improving patient-reported outcome metrics, construct integrity, cervical alignment, successful arthrodesis, and subsequent revision operations. There were 46 patients total, with 12 having 1-level PLATE, 12 having 1-level CAGE, 12 having 2-level PLATE, and 10 having 2-level CAGE. PLATE patients with 1-level ACDF had worse swallow function at 6 weeks (P=0.050) and 6 months (P=0.042) on the Swallowing Quality of Life Questionnaire. In addition, about 1 PLATE patient had pseudarthrosis that required revision. At 6 weeks, CAGE patients had a worse neck disability index (P=0.037), and at 6 months, they had a worse neck disability index (P=0.017) and visual analog scale neck (P=0.010). At 6 weeks, PLATE patients reported decreased swallow function (P=0.038) on the Swallowing Quality of Life Questionnaire. For both 1-level and 2-level ACDF, there were no changes in the fusion rates, loss of disc height correction, subsidence, or sagittal characteristics between cohorts. Single and 2-level PLATE cohorts had a higher rate of transitory postoperative dysphagia. However, 2-level CAGE had lower early postoperative results in several patient-reported metrics. This implied that, while anterior instrumentation might increase the risk of dysphagia, it also increased short-term stability and improved patient-reported results for 2-level fusion.
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