A system, device, and method are disclosed for anterior intervertebral fusion with fixation. An intervertebral fusion with fixation device includes a spacer configured to fit into a disc space between plural vertebrae, the spacer including through holes between and through plural sidewalls. A first fixating element is rigidly preloaded in a first portion of the spacer along a first linear trajectory. A second fixating element is rigidly preloaded in a second portion of the spacer along a second linear trajectory. An integrated drill and screwdriver instrument is adapted to extend through a cannula of the first fixating element and second fixating element and penetrate the vertebra. The instrument is further adapted to drive the head of the first fixating element and second fixating element into the vertebra and lock the first fixating element and second fixating element with respect to the spacer to prevent extrusion from the spacer.