One hundred twenty patients with degenerative cervical spine disease undergoing elective anterior cervical discectomy and fusion (ACDF) were randomised to receive either a microcuff endotracheal tube (Group M; n=60) or a wire-reinforced endotracheal tube (Group W; n=60). The primary outcome of interest was postoperative hoarseness of voice. Secondary outcomes included sore throat, dysphagia, stridor, vocal cord palsy, airway oedema at extubation, and intraoperative changes in cuff pressure and cuff inflation volume associated with cervical retractor application. Outcomes were assessed intraoperatively and at 6, 24, and 48 hours after extubation. Overall, the results of the study revealed that microcuff tubes required lower cuff volumes and generated lower cuff pressures at baseline and during retraction, and were associated with a significantly lower incidence of postoperative hoarseness, while rates of sore throat, dysphagia, vocal cord dysfunction, airway oedema, and stridor were similar between groups. These findings suggest that microcuff endotracheal tubes, combined with careful cuff pressure management, may reduce laryngotracheal morbidity after ACDF compared with wire-reinforced tubes.