Study DesignSystematic review and meta-analysis.ObjectivePoor bone quality is a major risk factor for complications after cervical spine surgery. The MRI-based cervical vertebral bone quality (C-VBQ) score is a reliable tool for assessing bone quality. This study systematically evaluates, for the first time, the predictive value of C-VBQ for cage subsidence risk in cervical spine surgery patients using meta-analysis.MethodsWe conducted a comprehensive search of relevant literature in electronic databases up to October 16, 2024, to systematically assess the quality of included studies. Publication bias was evaluated by comparing C-VBQ between groups and calculating pooled sensitivity, specificity, and summary receiver operating characteristic (SROC) curves.Results7 studies involving 681 patients were included. Using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool, the studies were deemed high quality with low risk of bias. High C-VBQ scores were significantly associated with fusion subsidence, with a pooled odds ratio of 2.98 (95% CI: 1.68-5.30). The C-VBQ cut-off value was 2.94 ± 0.32, and the combined sensitivity and specificity for diagnosing postoperative complications were 0.78 and 0.87, respectively, with an area under the curve of 0.90 (95% CI: 0.87-0.92).ConclusionIn patients undergoing degenerative cervical spine surgery, higher C-VBQ scores were significantly associated with an increased risk of cage subsidence. The C-VBQ score is a reliable tool for preoperative bone quality assessment and serves as an independent predictor of cage subsidence risk following cervical spine surgery.