BACKGROUND: Recent researches confirm that there is a prevalence of depression in patients with cervical spine disease such as cervical spondylosis. Emotional distress has been found to be relevant to back pain surgical outcome, but their influence has not been prospectively evaluated for cervical spine surgical outcomes. If the relationship between depressed mood and poor cervical spine surgical outcomes was confirmed, spine surgeons could use a brief screening instrument to identify patients who might benefit from consultation with a psychiatrist. METHODS: Data from subjects enrolled in a single medical center were analyzed. Data collection occurred at baseline, 3 months and 12 months. Emotional distress were measured with the 9-Item Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PHQ-9). At follow-up, patients completed measures of 12-Item Short-Form Health Survey (SF-12), Neck Disability Index (NDI), and Numeric Rating Scale (NRS). A total of 61 subjects completed the one year follow-up. Demographic (age and gender) and social (marital status, employment status, and receiving disability funds) characteristics were recorded. RESULTS: PHQ-9 with lower scores group predicted less neck and arm pain (NRS) after surgery. Similarly, PHQ-9 with lower scores group predicted better physical function (NDI, SF-12) after surgery. Other significant contributors were included, such as receiving disability funds, duration of pain before surgery, and employment status. CONCLUSIONS: Depression influences pain and function after cervical disc arthroplasty. Further studies need to identify and intervene with patients with poorer emotional status, which will clarify whether presurgical mental health intervention can improve pain and functional outcomes after surgery or whether these patients are not candidates for surgery.