ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicFrontiers in Spine Surgery: Techniques, Technology, and Translational ResearchView all articles
Comparison between plate cage system and stand-alone cage in the treatment of cervical spondylotic myelopathy patients with cervical kyphosis: clinical and radiographic outcomes
Provisionally accepted
- 1Shanghai Tenth People's Hospital Department of Orthopedics, Shanghai, China
- 2Changhai Hospital Department of Orthopedics, Shanghai, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: To compare mid-term outcomes of plate cage systems (PC) versus stand-alone cages (SA) in two-level ACDF for cervical spondylotic myelopathy (CSM) with cervical kyphosis, and to assess the influence of preoperative segmental kyphosis reducibility on sagittal alignment maintenance. Methods: This retrospective cohort analyzed 130 patients (SA=64, PC=66) with ≥ 24-month follow-up. Radiographic parameters (cervical lordosis [CL], fusion segmental lordosis [FSL], disc wedge, C2 SVA) and clinical outcomes (NDI, VAS, JOA, EQ-5D, dysphagia) were assessed preoperatively, postoperatively, and at final follow-up. Patients were stratified based on preoperative reducibility of segmental kyphosis. Results: Both groups showed comparable clinical improvement (p<0.05) and fusion rates (93.8% SA vs. 95.4% PC, p=0.667). SA had shorter operation time (78.0±11.5 vs. 86.6±12.5 min, p<0.001), less blood loss (193.0±85.6 vs. 256.7±110.3 mL, p<0.001), and lower dysphagia incidence (12.5% vs. 20.3%, p=0.014). However, the PC group demonstrated superior maintenance of cervical sagittal alignment in CL (13.6°±0.9° vs. 12.3°±2.4°, p<0.001), FSL (13.2°±1.2° vs. 11.9°±2.9°, p=0.001), and disc wedge (10.2°±1.3° vs. 8.9°±2.6°, p<0.001) at follow-up, particularly in patients with non-reducible kyphosis (p<0.05). Conclusion: SA offers operative efficiency advantages, while PC is more effective in maintaining sagittal alignment, especially in rigid kyphosis. PC is recommended for patients with non-reducible cervical kyphosis.
Keywords: Anterior cervical discectomy and fusion, Cervical kyphosis, plate cage system, Sagittal alignment, stand-alonecage
Received: 18 Nov 2025; Accepted: 23 Jan 2026.
Copyright: © 2026 Wang, Liu, Yuan and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhi-cai Shi
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.