Abstract Background Data: Anterior cervical discectomy and fusion (ACDF) is a gold-standard option for treating cervical degenerative disc diseases (DDD). Anterior plating enhances stabilization with improved outcomes and reduced risk of pseudarthrosis yet with annoying morbidities. Fusion with stand-alone cages avoids such complications, although its use in multilevel disc arthrodesis is still controversial. Study Design: Retrospective multicenter comparative cohort study. Purpose: To evaluate clinical and radiological long-term outcomes after ACDF with stand-alone polyetheretherketone (PEEK) cages versus ACDF with cages and plating. Patients and Methods: Patients who underwent four-level stand-alone ACDF (Group 1) or ACDF with plating (Group 2) between July 2012 and May 2016 and followed up for at least two years were recruited for this study. In this study, the reported outcome parameters included operative time, operative blood loss, fusion rate, cervical curve, neck disability index (NDI), Visual Analogue Score (VAS) of neck pain, patient satisfaction, and perioperative morbidity. Results: Forty-seven patients, including 25 males and 22 females, were reported. The mean age was 50.8 and 50.1 years in Groups 1 and 2, respectively. Twenty-four patients underwent stand-alone ACDF and 23 underwent ACDF with plating. The baseline characteristics data of both groups were homogeneous between groups. The outcome parameters (NDI, cervical curve VAS scores, fusion rate, complications, reoperation rate, and patient satisfaction) showed no significant difference between the two groups at different time points of follow up. Pre- and postoperative NDI and VAS showed significant improvement in both groups. Dysphagia was reported more frequently in Group 2. Conclusion: Four-level ACDF with stand-alone PEEK cage is equally effective as ACDF with anterior plating in patients treated for four-level cervical DDD with less incidence of dysphagia. (2021ESJ233)