Comparison of Two-Screw Versus Four-Screw Internal Fixation on Fusion Speed in Anterior Cervical Discectomy and Fusion : A Prospective Randomized Controlled Trial.
Cheng-Yi Huang, Xia-Qing Sheng, Xing-Jin Wang et al.
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In 30 seconds
This prospective randomized controlled trial compared two-screw with four-screw internal fixation during single-level anterior cervical discectomy and fusion (ACDF) for cervical spondylosis. Of 80 patients randomized, 77 completed the trial and were analysed. At six months, fusion was more frequent with two screws than four screws (69.2% vs . 42.1%, P =0.022); fusion rates did not differ significantly at three or 12 months. Patient-reported outcomes improved after surgery in both groups, with no significant between-group differences, and complication prevalence was also similar. The findings suggest an early fusion advantage without detected differences in reported clinical outcomes or safety.
Key findings
- At six months, fusion rates were 69.2% with two-screw fixation and 42.1% with four-screw fixation (P =0.022).
- Fusion rates did not differ significantly between groups at three or 12 months.
- Patient-reported outcomes improved in both groups, with no significant between-group differences at follow-up.
- Complication prevalence was not significantly different between fixation groups.
Why it matters
Fusion timing is a relevant outcome when selecting fixation approaches for ACDF. In this randomized comparison, the two-screw construct was associated with a higher six-month fusion rate, while patient-reported outcomes and complications were similar between groups. The absence of a difference at later follow-up means the observed advantage concerns earlier fusion rather than a demonstrated difference in eventual fusion or clinical benefit.
What to keep in mind
The trial included 77 analysed patients with single-level cervical spondylosis; the abstract does not report longer-term outcomes beyond 12 months.