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Objective   The number of surgical techniques of decompression and solid interbody fusion as a treatment for cervical degenerative disc disease (DDD) has increased rapidly. Cage-assisted anterior cervical discectomy and fusion (ACDF) has proven to be a safe and effective procedure for one and two-level DDD. Multilevel cervical discectomy usually requires plate and screw fixation for maintaining the spinal curvature and increasing the graft fusion rate. Clinical results after three or four-level interbody cage-augmented ACDF have been reported in very few literatures. We investigated the safety and effectiveness of cages used in such procedures without plate fixation and evaluated the results.Methods   Forty-five patients suffering from three or four-level cervical DDD underwent cage (PEEK or titanium)-assisted ACDF without plate fixation. The cervical DDD was confirmed by radiography and magnetic resonance imaging. The patients underwent radiographic evaluation to assess cervical lordosis, segmental height of cervical spine, foraminal height, cross-sectional area of foramina, the angle between the two adjacent endplates, and spinal stability. Neurological outcomes were assessed using the Prolo scale. Neck pain was assessed using the visual analogue scale (VAS). The follow-up period ranged from 27 to 53 months (mean, 35 months).Results   A significant improvement ( p &lt; 0.001) in the Prolo scale scores (preoperatively 7.9 ± 1.7 and postoperatively 8.7 ± 1.1) and VAS pain scores (preoperatively 8.8 ± 1 and postoperatively 3 ± 1.5) was demonstrated. A significant increase in cervical lordosis, segmental height, foraminal height, cross-sectional area of foramina, and angle between the two adjacent endplates was noted. Good stability was obtained in all patients 12 months postoperatively and the complication rate was 0%.Conclusion   Multilevel (3 or 4) anterior cervical discectomies and cage (PEEK or titanium)-augmented interbody fusion without plating is a good method for management of multilevel cervical DDD. It provides long-term stabilization, increases lordosis, segmental and foraminal height, and cross-sectional area of foramina. Satisfactory neurological outcomes can be obtained and donor site complication can be avoided.

Multilevel Anterior Cervical Discectomies and Cage-Augmented Fusion without Plate Fixation