Outcome and complications after two-level Anterior Cervical Discectomy and Fusion (ACDF) with or without plating. A propensity matched cohort study

Anterior cervical discectomy and fusion (ACDF 1 ) is the current standard of treatment for disc herniation and radiculopathy resistant to non-operative care and can be performed with or without plating. Which method of two-level ACDF with or without fixated plate, results in better outcome due to patient-reported outcomes measures (PROMs 2 ), subsidence and revision rates? A consecutive cohort of patients undergoing two-level ACDF were enrolled in the study and stratified into cases with or without plating. Standard demographic and surgical data, surgical technique, radiographs, pre- and postoperative PROMs were gathered. Propensity matching was used to minimize baseline differences. A total of 86 (89.6%) patients undergoing two-level ACDF surgery had completed pre-op and one-year follow-up data. Two matched cohorts consisting of 37 patients were created. Plated patients reported significantly lower neck-pain (24.1 vs. 40.1 p=0.018) and higher EuroQol scores(0.76 vs 0.62 p=0.038) one year after surgery compared to those without. At follow-up, there were no difference in reports of dysphagia (15 vs 15, p=0.808), hoarseness (9 vs 13,p=0.298), subsidence (8 vs 9, p=1.000) or revision rates (1 vs 2, p=0.389) between the two groups. Anterior plating in patients undergoing two-level ACDF leads to less neck pain compared to no plate 1 year postoperative, but does not reduce cage subsidence or reoperation rate. • The use of ACDF with or without plating is debatable. • PROMs after two-level ACDF with plate claims less neck pain compared to no plating. • There was no significant difference due to subsidence, revision rate or dysphagia. • No patient had persistent dysphagia 3 months postoperatively.