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Patients were treated with either stand-alone porous titanium cages or anchored zero-profile PEEK cages. Clinical outcomes were assessed using the NRS and the SF-12 questionnaire. Radiological outcomes included intersomatic fusion, cage subsidence, and sagittal alignment parameters. Fusion was evaluated on static cervical radiographs at 12 months. Complications and revision surgeries were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 265 patients were included (121 stand-alone; 144 anchored). Baseline demographic and clinical characteristics were comparable between groups. Operative time was significantly shorter in the stand-alone group (85 vs. 112\u00a0min). Both groups showed significant postoperative improvement in pain and functional scores. The magnitude of pain reduction was greater in the stand-alone cohort, while SF-12 improvement was comparable. Fusion rates (88.4% vs. 92.3%), subsidence rates (5.7% vs. 4.1%), complication rates, and sagittal alignment parameters did not differ significantly between groups. Osteoporosis was the only factor associated with an increased risk of cage subsidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this multicenter study, stand-alone 3D-printed porous titanium cages achieved clinical and radiological outcomes comparable to anchored PEEK cages in ACDF, with shorter operative times, preserved sagittal alignment, and similar complication, fusion, and subsidence rates. 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