Objective <p>This study aims to evaluate the value of the Cervical Vertebral Bone Quality (C-VBQ) score in predicting adjacent segment degeneration (ASD) after single-level anterior cervical discectomy and fusion (SL-ACDF). The analysis of relevant clinical data is expected to provide a basis for post-operative rehabilitation and intervention.</p> Methods <p>A retrospective screening was performed on 236 patients with cervical degenerative disease treated with SL-ACDF from 2018 to 2023. Among them, 159 patients who met the inclusion criteria were included in the final analysis. Patients were stratified into ASD and non-ASD groups. Preoperative VBQ scores, derived from MRI, were evaluated together with radiographic characteristics (e.g., disc degeneration grade, C2-7 Cobb angle) and clinical factors (e.g., age, diabetes). Risk factors were identified through univariate and multivariate logistic regression, and the predictive performance of the scores was assessed using receiver operating characteristic (ROC) curve analysis.</p> Results <p>The incidence of ASD was 28.9%. Multivariate analysis identified the C-VBQ score as an independent predictor of ASD (OR = 3.935, 95% CI: 1.406–11.017, <i>p</i> = 0.009). ROC analysis demonstrated that the C-VBQ score had the highest predictive value for ASD (AUC = 0.742). Additionally, factors such as gender, preoperative adjacent segment disc degeneration, and C2-7 Cobb angle were also independent risk factors for ASD (<i>p</i> &lt; 0.05).</p> Conclusion <p>The VBQ scoring system could be a useful auxiliary tool in predicting ASD after SL-ACDF.</p>