Study Design: Retrospective analysis of prospectively collected data.Objective: The aim of the study was to compare the outcome of anterior cervical decompression and fusion (ACDF) with standalone tricortical iliac crest autograft versus stand-alone polyetheretherketone (PEEK) cage in cases of cervical spondylotic myelopathy.Methods: Prospectively collected data of 60 patients in each group were compared.Results: There was statistically significant improvement noted in postoperative Modified Japanese Orthopaedic Association (MJOA) follow-up scores with comparison pairs of preoperative versus 6 months, preoperative versus 1 year, and 3 months versus 6 months, 3 months versus 1 year in both groups. But improvements in MJOA scores were statistically insignificant between 6 months and 1 year (P ¼ .0639) for the autograft group when compared with PEEK cage group (P ¼ 0001). The mean loss of segmental lordosis on follow-up X-ray for the autograft group was (5.89 + 2.90 ), which was significantly higher (1.88 + 2.77 ) than the mean loss seen in the PEEK cage group (P ¼ .01). This was most evident between 6 months and 1 year, resulting in plateauing of the improvement in MJOA score between 6 months to 1 year in the autograft group. While there was no statistical difference between fusion rates between the groups for 1 and 2 levels of ACDF, overall fusion rates were significantly better for 1-level ACDF (95.74%) when compared with 2-level ACDF (76.00%). Conclusion: ACDF with PEEK cage is the fusion technique of choice for cervical fusion with fewer complications and better functional recovery in the treatment of cervical spondylotic myelopathy.

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