We aimed to identify independent psychological predictors of quality of life (QoL) and functional outcome after anterior cervical discectomy and fusion (AcDf) for degenerative cervical spine disease. We prospectively included patients undergoing AcDf for degenerative cervical disc herniation and stenosis. patients completed a structured psychological assessment including the center for Epidemiological Studies Depression Scale (ADS-K), Post-Traumatic Stress Scale-10 (PTSS-10), State trait Anxiety inventory-State Anxiety and-trait Anxiety (StAi-S and StAi-t) and Anxiety Sensitivity Index-3 (ASI-3) before surgery, after 3 and 12 months. Outcome measures included EuroQol-5D (EQ), Short Form-36 (SF-36) and Oswestry Disability Index (ODI) scores. Of 104 included patients who underwent ACDF between March 2013 and November 2017, 92 completed follow-up after 3 and 12 months. The mean Visual Analogue Scale (VAS) scores for neck pain (− 1.4; p < .001) and arm pain (− 1.8; p = .031) significantly decreased by 12 months. QOL scores significantly increased by 3 months (EQ: + 0.2; p < .001; SF-36 PCS: + 6.2; p < .001; SF-36 MCS: + 2.5; p = .044), a benefit which was retained at 12 months. Linear regression analyses identified statistically significant predictors in preoperative ASI-3, SF-36 MCS and STAI-S for postoperative QOL and ODI scores. There is a benefit for patients in terms of quality of life and function after undergoing surgery for degenerative cervical spine disease. With the ASI-3, SF-36 MCS and STAI-S there exist some predictors for postoperative QOL and ODI scores. Degenerative diseases of the cervical spine are known to encompass a variety of pathologies producing pain, disability and impaired health-related quality of life (QOL). Surgical treatment of these pathologies via an anterior cervical discectomy and fusion (ACDF) procedure has been documented with favourable results in an abundant number of case series 1-7. Despite several testaments to the benefit of the procedure, there are patients who may benefit to a lesser extent than desired, at times requiring the operating surgeon to consider altering their treatment strategy accordingly. Various research groups have investigated somatic predictors of impaired QOL after ACDF 8-10. However, while evidence demonstrating the significant influence of a psychological predisposition of patients on QOL and the functional outcome after surgery for degenerative diseases in the thoracolumbar region continues to emerge, to the best of our knowledge, only a few studies have addressed these aspects after ACDF prospectively 11-15. The available evidence concerning outcome for the cervical spine suggests somewhat conflicting results, without an unambiguous solution for a routinely feasible and reliable psychological assessment of patients. To assume that the psychological profile directly modulates a patient's perception of pain and disability seems