OBJECTIVES: The purpose of this research was to investigate the safety and effectiveness of locking stand-alone cages (LSC) versus cage and plates (CP) in single-level fusion used to treat 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 LSC and CP 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 15 studies (2 RCT and 13 NRS) were included. The LSC group had statistically significant (P < 0.05) less blood loss (MD = -12.01 mL; 95% CI: -17.09, -6.93), shorter operation times (MD = -7.01 minutes; 95% CI: -13.35, -0.68) and hospital stays (MD = -0.77 days; 95% CI: -1.50, -0.05), and decreased incidence of dysphagia (OR = 0.14; 95% CI: 0.05, 0.40) compared to the CP group. There were no significant differences in the neck disability index (NDI), Japanese Orthopedic Association (JOA) scores, neck pain (visual analog scale), fusion rates, or subsidence rates.

CONCLUSIONS: The available evidence, although limited, showed that LSC achieved better outcomes compared to CP in regard to dysphagia, operation times, blood loss, and hospital stays. Further large-sample RCTs are needed to confirm and expand the results of this study.