Is it necessary to place screws in the intervening vertebrae in two-level anterior cervical discectomy with fusion and plating?

• The clinical efficacy of the two methods of screw placement was similar. • The incidence of complications was the same for two methods of screw placement. • ACDF (middle vertebra without screw) had shorter screw placement time and less implant cost. The clinical outcomes, radiological parameters, complication rate and the cost of implants in two-level ACDF with and without screws in the intervening segment were compared. A retrospective study of 68 patients who underwent 2-level ACDF from January 2014 to June 2016 was performed. The patients were divided into two groups: ACDF with screws in the intervening vertebra and those without screws in the intervening vertebra. Perioperative factors, clinical outcomes, postoperative complications, radiological parameters, and cost of the implants were evaluated in both groups. No statistical differences in clinical outcomes, operative blood loss, hospital stay, restoration of cervical lordosis or segment height, postoperative complications, and fusion rate were found between the ACDF (middle vertebra with screw) and ACDF (middle vertebra without screw) groups (P > 0.05). But the operative time of added screw placement and cost of implants in the ACDF (middle vertebra without screw) group were significantly less than the ACDF (middle vertebra with screw) group (P < 0.05). Two kinds of screw placement with ACDF were found to be similar in terms of clinical outcomes. However, ACDF (middle vertebra without screw) was found to be superior to ACDF (middle vertebra with screw) in terms of the screw placement time and cost of implants. [ABSTRACT FROM AUTHOR]