BACKGROUND CONTEXT Disc space collapse often occurs later in the natural course of cervical degenerative disc disease, and during anterior cervical discectomy and fusion (ACDF), restoration of disc space height and lordosis can assist with decompression and restoration of alignment. It is unclear if the amount of preoperative cervical disc space collapse correlates with outcomes following ACDF. PURPOSE The aim of the present study was to characterize preoperative disc space height in a sample of ACDF patients and to determine the association with postoperative clinical and radiographic outcomes following ACDF. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Analysis of consecutive patients who underwent a single-level ACDF between 2008-2015 for cervical radiculopathy and/or myelopathy, with more than 6 months of clinical and radiographic follow-up was conducted. Exclusion criteria were patients under 18 years of age at the time of surgery, previous cervical fusion or concomitant posterior cervical surgery, had postoperative follow up less than 6 months, or had an ACDF for cervical spine fracture, tumor, or infection. OUTCOME MEASURES Preoperative disc height was measured in terms of preoperative anterior vertebral distance (pAVD), mid-vertebral distance (pMVD), and posterior vertebral distance (pPVD). Sagittal parameters were also measured, and included change in C2-C7 lordosis, T1 angle, levels fused, sagittal vertical axis (SVA), fusion mass lordosis, proximal and distal adjacent segment lordosis. Visual Analog Scale (VAS) neck, VAS arm, and Neck Disability Index (NDI) scores were collected at each postoperative clinical visit. The rates of adjacent segment disease, reoperation, fusion, and subsidence (postoperative disc space collapse >2mm) were determined for the study period. METHODS Radiographs were reviewed preoperatively and immediately postoperatively, and at final follow up along with patient-reported outcomes. Bivariate and multivariate logistic regressions were subsequently used to compare clinical outcomes between disc height. Multivariate analyses controlled for differences in baseline patient characteristics. RESULTS A total of 120 patients were included. At final follow-up, pAVD was associated with increased lordosis, SVA and proximal lordosis. Additionally, pMVD was associated with increased postoperative SVA (p=0.025), and final SVA (p=0.011). Preoperative PVD was associated with decreased postoperative distal lordosis (p=0.037) and increased final SVA (p=0.032). Notably, greater pAVD was associated with greater final VAS arm scores (p=0.022), greater pMVD was associated with increased final VAS neck (p=0.037) and final VAS arm scores (p=0.040), and greater pPVD was associated with greater final VAS neck (p=0.031) and arm (p=0.023) scores. Greater AVD, MVD, and PVD were all associated with a decreased preoperative to postoperative difference in VAS neck (p-value range 0.034-0.04). CONCLUSIONS Increased anterior, middle and posterior preoperative disc height were all associated with increased final SVA, among other parameters. Patients with well-maintained preoperative disc heights had greater final VAS neck scores, VAS arm scores, and had less postoperative improvement in VAS neck scores compared to patients with preoperative collapsed discs. These results suggest that patients with preoperative cervical disc space collapse may have superior outcomes compared to patients with maintained cervical disc height, and future studies are needed to further explore these differences. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.