Objective:To compare the outcome of autologous bone graft versus PEEK cages in ACDF surgery in terms of clinical performance and radiographic features.
 Methodology:This study was conducted at Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan from April 2020 to December 2022. In this study patients were randomized into two equal groups i.e. Group A (autologous bone graft) and Group B (PEEK cage).
 Results: Total of 98 patients was included in the study. The mean age of cases was 49.88 ± 17.83 years. There were 58(59.18%) male and 40(40.82%) female cases. 25(25.51%) cases who had C3-C4 involved, 48(48.98%) patients had C5-C6 and 25(25.51%) cases had C5 region involved. The mean disc height at 6th months in PEEK group was 6.71 ± 0.46 mm and in bone graft group was 6.33 ± 0.47 mm, p-value < 0.05. The mean operative time in PEEK group (2.07 ± 0.42) was statistically less than bone graft group (3.23 ± 0.36), p-value < 0.05. The average blood loss was also statistically less in PEEK group as compared to bone graft. The mean hospital stay in PEEK group was 2.92 ± 0.61 days as compared to bone graft was 5.48 ± 1.90 days, p-value < 0.05.
 Conclusion:Outcome of ACDF surgery PEEK cages are better than autologous bone graft in terms of clinical performance and radiological features. Hence PEEK cages can be opted in future to have better outcome and higher patient’s satisfaction.