Aim:Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for degenerative cervical spine conditions. The use of anterior plating alongside cage-only techniques in ACDF remains a topic of debate due to concerns regarding sagittal alignment, clinical outcomes, complications and adjacent segment pathology.In this study, we aimed to compare fusion with anterior plating and cage (PLATE) versus cage-only (CAGE-O) technique on postoperative cervical sagittal alignment parameters, clinical outcome and complication profiles following two-level ACDF.Material and Methods:Clinical and radiological data of 42 patients undergoing two-level ACDF with either cage-only or anterior plating were retrospectively analyzed. Sagittal alignment parameters, including cervical lordosis, C0-C2 angle, T1 slope, and cervical sagittal vertical axis (cSVA), were evaluated preoperatively and postoperatively. Clinical outcomes were evaluated with visual analog scale (VAS) and Neck Disability Index (NDI) scores.Results:Both groups demonstrated significant clinical improvement in VAS and NDI scores over a two-year follow-up period. Postoperatively, CAGE-O group exhibited significant increase in C0-C2 angles and had a tendency in T1 slope, while PLATE group showed no significant increase. Cervical lordosis and cSVA values did not show significant change postoperatively in both groups. Complication rates were similar between PLATE and CAGE-O groups.Conclusion:Both anterior plating and cage-only techniques in two-level ACDF demonstrated comparable outcomes in terms of sagittal alignment, clinical improvement, and complication rates. These findings suggest that the decision to utilize anterior plating should be based on individual patient factors and surgeon preference rather than differences in outcomes.