Comparison of Two-Screw Versus Four-Screw Internal Fixation on Fusion Speed in Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Trial

BACKGROUND CONTEXT: The insertion process of the new two-screw internal fixation is simpler than that of four-screw internal fixation for anterior cervical discectomy and fusion (ACDF). However, it is unclear whether there is a difference in fusion rate. PURPOSE: This study aimed to compare the time required to achieve osseous fusion and the clinical efficacy of four-screw versus two-screw internal fixation. STUDY DESIGN: A prospective randomized controlled trial. PATIENT SAMPLE: From October 2021 to April 2023, 80 patients diagnosed with single-level cervical spondylosis were recruited and randomly allocated into a four-screw or two-screw group. OUTCOME MEASURES: The primary end point was the fusion rate six months postoperatively. Secondary outcomes included the prevalence of complications and patient-reported outcome measures (PROMs), including the Japanese Orthopaedic Association score, Neck Disability Index, and visual analog scale scores for arm and neck pain. METHODS: Patients were randomized to receive four-screw internal fixation (n=40) or two-screw internal fixation (n=40). RESULTS: A total of 77 patients completed the trial and were included in the analysis. No significant differences were observed between groups at baseline. The fusion rate in the two-screw group was significantly higher than that in the four-screw group (69.2% vs . 42.1%, P =0.022) at six months postoperatively. No significant difference was found in the fusion rates at 3 and 12 months postoperatively between groups. Overall, PROMs significantly improved after surgery in both groups and did not differ significantly between groups at any follow-up time point. The prevalence of complications was not significantly different between groups. CONCLUSIONS: Two-screw internal fixation can achieve osseous fusion faster than four-screw internal fixation in ACDF. Two-screw internal fixation seems to achieve the same PROMs and safety as four-screw internal fixation.