Objective: To explore the predictive value of the subcutaneous fat index (SFI) of the cervical spine in predicting residual cervical axial pain after anterior cervical corpectomy and fusion (ACCF). Methods: 120 patients who underwent ACCF were selected as the research subjects. They were divided into an observation group (n=35) and a control group (n=85) based on the presence of residual neck axial pain. The general clinical data of the two groups were compared, including age, gender, body mass index (BMI), length of hospital stay, history of hypertension, diabetes mellitus, smoking history, duration of surgery, intraoperative bleeding, operated vertebral segments, dural injuries and preoperative and postoperative clinical efficacy scores, and the preoperative and postoperative clinical efficacy scores were measured by measuring the subcutaneous fat thickness of the cervical vertebral segments subcutaneous fat thickness (SFT) and muscle thickness of cervical spine segments were measured and SFI was calculated. Risk factors for postoperative residual cervical axial pain were analyzed by univariate and multivariate Logistic regression. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of SFI for residual neck axial pain after ACCF surgery. Results: The hospitalization time and BMI were higher in the observation group than in the control group (P<0.05), and the SFT and SFI were increased (P<0.05). There was no significant difference in VAS and cervical spine dysfunction index (neck disability index, NDI) between the two groups preoperatively and at 2 months postoperatively (P>0.05), but at 3, 6, and 12 months postoperatively, VAS and NDI scores in the observation group were higher than those in the control group (P<0.05). Univariate analysis showed that BMI, dural injury and SFI were risk factors for residual neck axial pain after ACCF (P<0.05), but multivariate Logistic regression analysis showed that there was no significant correlation between BMI, dural injury and residual cervical axial pain after ACCF surgery (P>0.05). Univariate and multifactorial Logistic regression analyses showed that SFI was associated in the residual neck axial pain group (P<0.05), and was a risk factor for postoperative residual neck axial pain. The ROC curve showed an AUC of SFI of 0.907 (95%CI: 0.848~0.965), with an optimal cutoff value of 0.955 (sensitivity 85.7%, specificity 89.4%). Conclusion: A higher SFI is associated with residual cervical axial pain after ACCF surgery. It is recommended to evaluate SFI preoperatively as an effective indicator for predicting residual cervical axial pain after surgery.