OBJECTIVES: The purpose of this research was to compare the safety and effectiveness of anterior plated versus non-plated fixation in single-level anterior cervical discectomy and fusion (ACDF) for degenerative cervical disease.

METHODS: We conducted online searches of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, KoreaMed and KMbase. We selected randomized controlled trials (RCT) or non-randomized controlled studies (NRS) comparing anterior plated versus non-plated fixation in single-level fusions used to treat degenerative cervical disease. Two reviewers independently examined the articles based on eligibility, extracted data and evaluated the risk of bias (RoB). Assessment of the RoB was performed using the Cochrane RoB tool for RCT and the RoB Assessment tool for NRS (RoBANS 2.0), respectively. Dichotomous variables were pooled using the odds ratio (OR) and continuous variables were pooled using the mean difference (MD). The 95% confidence interval (CI) was calculated.

RESULTS: A total of 10 studies (2 RCT and 8 NRS) were included in the analysis. The plate group had statistically significant (P < 0.05) lower subsidence rates (OR = 0.34; 95% CI: 0.22, 0.52; 8 NRS) and higher fusion rates (OR = 2.87; 95% CI: 1.48, 5.17; 7 NRS) compared to the cage-only group. There were no significant differences in the neck disability index (NDI; 2 NRS), neck pain (3 NRS), or arm pain (2 NRS).

CONCLUSIONS: Available evidence, although limited, showed that cages with plates achieved better outcomes regarding subsidence rates and fusion rates compared to cage-only procedures. Further large-sample RCTs are needed to confirm and update the results of this study.