Corresponding Author

Mohamed Al-Seqely, MD.

Authors ORCID


Subject Area

Cervical spine, Degenerative

Document Type

Original Study


Background Data: Degenerative cervical spondylosis (DCS) is a common health problem spine surgeons face in Egypt. This may affect multiple levels with cord or nerve root affection and is associated with changes in cervical lordosis that affect the outcome. Also, its surgical treatment, either by anterior discectomy and fusion by cages only or with an anterior augmentation plate, is a matter of controversy, especially in cases with more than one level of affection.

Purpose: This study aims to look at the outcomes of using a stand-alone anatomical Fidji cervical cage for multilevel anterior cervical discectomy and fusion (ACDF) to treat DCS

Study Design: A prospective clinical case study.

Patients and Methods: Between May 2021 and April 2022, 30 patients with symptomatic DCS had multilevel ACDF using a stand-alone anatomical Fidji cervical cage. The surgery took place at the spine unit of Al-Hadara and Al-Moassa Alexandria University Hospital. Fourteen were female, and sixteen were male, with a mean age of 54 ± 12.5 years. An evaluation was conducted to determine their clinical and radiological outcomes. Evaluation parameters were visual analog scale (VAS), bone fusion, cervical lordosis angle, and Odom’s criteria for the outcome.

Results: The mean follow-up was 12 months. The fusion rate was 98.88%, with an incomplete bridging trabecular bone between end plates reported at one level. The mean VAS score for neck pain and arm pain improved from 5.87 ± 0.86 and 5.6 ± 0.73 at the preoperative to 1.6 ± 0.67 and 1.37 ± 0.49 at the last follow-up, respectively. The cervical lordosis improved from 22.03° ± 2.86° to 23.53° ± 3.19° at the last follow-up. Employing Odom’s criteria for ultimate evaluation at the last follow-up showed that the clinical outcome was excellent in 70% of patients, good in 26.6%, and fair in 3.4%.

Conclusion: Using multilevel ACDF with a stand-alone anatomical Fidji cervical cage is a safe and effective way to treat DCS, with a high rate of good short-term outcomes with preservation of cervical lordosis.


multilevel ACDF, Fidji cervical cage, Cervical spondylosis, Cervical lordosis, Stand-alone