The objective of this study is to determine bone mineral density (BMD) changes in adjacent vertebra following anterior cervical discectomy and fusion (ACDF). Consecutive patients undergoing ACDF with available preoperative and postoperative CT imaging were included. Quantitative computed tomography measurements of screw-free cervical and first thoracic vertebra were performed. Comparisons between pre- and post-operative BMD in the vertebrae one or two levels above the upper instrumented vertebra (UIV+1, UIV+2) and one level below the lowest instrumented vertebra (LIV+1) were assessed. 72 patients (men, 66.7%) met inclusion criteria. The patient population was 91.7% Caucasian with a mean age of 55.0 years. The mean interval (± SD) between surgery and secondary CT was 157 ± 23 days. Preoperative BMD (± SD) in UIV+1 was 300.6 ± 66.2 mg/cm3. There was a significant BMD loss of 1.5% at UIV+1 after surgery, resulting in a postoperative BMD of 296.2 ± 64.8 mg/cm3 (p=0.029). At UIV+2 and LIV+1, no significant differences between pre- and post-operative BMD (304.7 ± 75.7 mg/cm3 vs. 299.8 ± 74.3 mg/cm3, 197.3 ± 50.4 mg/cm3 vs. 200.8 ± 48.7 mg/cm3, p= 0.113 and p=0.078, respectively) were observed. Clinical Significance: Our results demonstrate a small BMD decrease of 1.5% at UIV+1. This suggests that the effect of ACDF surgery on the adjacent levels might be smaller compared to the previously described lumbar BMD loss of 10-20% following posterior lumbar fusion procedures. This article is protected by copyright. All rights reserved.