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Purpose Intervertebral device subsidence is one of the complications of anterior cervical discectomy and fusion. The biomechanical properties of vertebral bony endplate may be related to device subsidence. The aim of this study is to measure the cervical endplate bone density distribution using a novel 3D measurement method. Methods Eight human cadaver cervical spines were obtained and levels C3-C7 were dissected and CT scanned. Threedimensional (3D) CT model was created with the same 3D coordinates of the original DICOM dataset. The regional strength and stifness of the endplate were determined by indentation testing. The indentation points were recorded by a photograph and the location of the indentation points was projected to the 3D CT model. Three-dimensional coordinates of the indentation point was obtained in the 3D space determined by the DICOM dataset. The area underneath the indentation point was calculated by a trilinear interpolation method directly. Data in HU and correlations with the indentation strength and stifness were analysed. Results A positive correlation was found between HU and strength (r = 0.52) and between HU and stifness (r = 0.41). Overall, mechanical strength and stifness and HU in the superior endplate of the caudal vertebra were lower than those in the inferior endplate of the cranial vertebra in the same intervertebral disc. Conclusions The mechanical properties and the HU were found to be signiicantly correlated, which employed a novel 3D HU measurement method, thus demonstrating potential to predict cervical endplate failure risk in a clinical setting. Keywords Cervical endplate • Bone mineral density • Device subsidence • Indentation test • Anterior cervical discectomy and fusion Abbreviations ACDF Anterior cervical discectomy and fusion IVD Intervertebral disc DEXA Dual energy x-ray absorptiometry 3D Three dimensional HU Hounsield Units ROI Range of interest BMD Bone mineral density * Takeshi Hara

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