Is anterior cervical plating necessary for cage constructs in anterior cervical discectomy and fusion surgery for cervical degenerative disorders? Evidence-based on the systematic overview of meta-analyses

Study design: Systematic review of meta-analyses. Objective: To perform a systematic review of meta-analyses to compare the clinical and radiological outcomes following anterior cervical discectomy and fusion with stand-alone cage (SAC) and anterior cervical cage-plate constructs (ACCPC). Methods: The systematic overview was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and reported as per Cochrane Handbook for Systematic Reviews of Interventions following the methodology described in reporting Overview of reviews. Results: Based on the available level-1 evidence, SAC offers significantly better benefits over ACCPC, in terms of shorter operative time (p < 0.00001; I-2 = 0%), lower blood loss (p = 0.01; I-2 = 0%), lesser rates of post-operative dysphagia (p = 0.02; I-2 = 0%), reduced overall expenditure (p = 0.001) and long-term adjacent segment degeneration (ASD)/anterior longitudinal ligament ossification (ALO; p = 0.0003; I-2 = 0%). There is no significant difference between the two constructs with regard to fusion rates, functional outcome scores, follow-up radiological sagittal alignment parameters or cage subsidence. Conclusion: Based on the available evidence, SAC constructs in ACDF reduce blood loss, decreases operative time, mitigates post-operative dysphagia, lessens hospital-related expenditure and minimises long-term ASD rates.