Purpose <p>Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures performed. The choice of fusion material for ACDF is crucial due to its influence on surgical outcomes and patient-reported outcome measures (PROM). While previous studies have evaluated radiological and perioperative outcomes, limited evidence exists on the impact of fusion materials on PROMs. This study aims to compare conventional surgical outcomes and PROMs between patients receiving synthetic cages and autologous crista grafts.</p> Methods <p>This nationwide observational study utilized data from the Swedish Spine Registry (Swespine). All adults who underwent ACDF between 2006 and 2020 were eligible for inclusion. Patients with missing baseline or outcome data were excluded. Propensity score matching at a 2:1 ratio was performed to adjust for baseline differences.</p> Results <p>7,716 patients were included, with 92% (<i>n</i> = 7,107) receiving synthetic cages and 8% receiving autologous crista bone grafts (<i>n</i> = 609). After matching, the synthetic cage group showed significantly lower complication (1.6% vs. 3.1%, <i>p</i> = 0.028) and reoperation rates (2.5% vs. 4.6%, <i>p</i> = 0.014), and shorter hospital stays (2.14 ± 1.98 vs. 2.89 ± 2.05, <i>p</i> &lt; 0.001). PROMs at 1-year follow-up revealed no significant differences in neck and arm pain (Numerical Rating Scale (NRS) scores), Neck Disability Index (NDI), European myelopathy score, or quality of life (EQ-5D, EQ-VAS). Satisfaction rates were comparable (74% vs. 72%, <i>p</i> = 0.72).</p> Conclusion <p>In this matched analysis, synthetic interbody fusion cages were comparable to autologous crista bone grafts for ACDF, with no significant differences in PROMs at 1-year follow-up. However, synthetic cages were associated with lower complication rates, reoperation rates, and shorter hospital stays.</p>