STUDY DESIGN: Systematic review and Meta-analysis. OBJECTIVES: To quantify the association of preoperative depression on patient reported outcome measures (PROMS) after cervical spine surgery. METHODS: We systematically searched PubMed, Cochrane, Embase, Scopus, PsychInfo, Web of Science, and ClinicalTrials.gov until September 14, 2023. Studies including adults undergoing cervical spine surgery and comparing PROMs between depressed and non-depressed patients were included. The primary outcome was the postoperative RESULTS: After screening 3813 articles, 20 studies were included, encompassing 3964 patients (mean age 57, 51% males) with median follow-up duration of 12 months. There was significant heterogeneity in estimates of the primary outcome ( CONCLUSIONS: Patients with depression experienced similar improvements in disability, pain, and physical function after cervical surgery compared to patients without depression. However, patients with depression exhibited worse disease severity before and after surgery.