Abstract: Objective To compare the clinical effectiveness of zero-profile anchored spacer (ROI-C) and titanium plate combined with cage during anterior cervical discectomy and fusion (ACDF). Methods A total of 83 patients who were admitted into the Affiliated Hospital of Xuzhou Medical University and underwent ACDF due to cervical degenerative diseases from April 2015 to June 2017 were enrolled. There were 41 patients who received ROI-C fixation (the ROI-C group, group A) and 42 patients who were fixed with titanium plate combined with cage (the titanium plate combined with cage group, group B). Then, both groups were compared for operation time, intraoperative blood loss and complications. Furthermore, before surgery, 3 months after surgery and at the ending of final follow-up, their cervical function was evaluated by the Japanese Orthopedic Association (JOA) scores, neck disability index (NDI); the surgical efficacy was evaluated by the Odom criteria; the postoperative dysphagia was assessed by the Bazaz grading system; the cervical Cobb angle, intervertebral space, cervical fusion and adjacent-level ossification development were assessed by X-ray and CT. Results The mean follow-up time was (45.6±7.4) months for the ROI-C group and (44.2±6.2) months for the titanium plate combined with cage group. The ROI-C group presented remarkable decreases in operation time, intraoperative blood loss, postoperative dysphagia incidence, and adjacent-level ossification incidence, compared with the titanium plate combined with cage group (P<0.05). After surgery, both groups showed significantly improved JOA and NDI scores, compared with those before surgery (P<0.05). The cervical physiological curvature was effectively restored in both groups after surgery. Conclusions The use of ROI-C in ACDF can effectively restore the cervical physiological curvature, with fewer complications and satisfactory effectiveness, which is an effective and reliable method to treat cervical degenerative disc disease.