The Confounding Burden of Psychological Impairments in Cervical Spine Surgery

Inclusion Criteria: Patients at Risk: * Diagnosed of primary symptomatic cervical degenerative disc disease confirmed with appropriate imaging studies. * Etiologies will be limited to cervical disc herniation, spinal stenosis, low-grade (I and II) spondylolisthesis, spondylosis and degenerative disc disease. * Will be undergoing elective cervical spine surgery, not to exceed 5 levels. * Presence of both axial (neck pain) and appendicular (arm pain/dysesthesia/weakness) symptoms, regardless of proportion * Subject must be able to be contacted by telephone during study participation * NDI \> 20% * Read and comprehend English Inclusion Criteria for patients with zero risk: * Diagnosed of primary symptomatic cervical degenerative disc disease confirmed with appropriate imaging studies. * Etiologies will be limited to cervical disc herniation, spinal stenosis, low-grade (I and II) spondylolisthesis, spondylosis and degenerative disc disease. * Will be undergoing elective cervical spine surgery, not to exceed 5 levels. * Presence of both axial (neck pain) and appendicular (arm pain/dysesthesia/weakness) symptoms, regardless of proportion * Subject must be able to be contacted by telephone during study participation * NDI \> 20% * Read and comprehend English Exclusion Criteria: Exclusion Criteria for patients at risk: * Contraindicated to surgical treatment of the cervical spine. * Prior cervical fusion * Evidence of severe cervical spinal deformity based on Ames classification: C2-C7 SVA \> 8cm, Horizontal Gaze \< -10 or \> 25, T1S-CL \> 20, myelopathy (JOA score \<10) or severe adult spinal deformity based on SRS-Schwab classification (PI-LL \> 20, PT \>30, SVA \> 90 mm) * Undergoing simultaneous treatment for thoracolumbar spine related diagnoses at the time of enrollment History of any spinal surgery within the last 6 months * Patients with neck pain attributable to trauma, idiopathic deformity, neoplasm, osteoporosis, or other medical condition. * Unlikely to comply with the follow-up evaluation schedule * Subject has recent history of chemical substance dependency that may impact the outcome or study participation Exclusion Criteria for patients with zero risk: * Contraindicated to surgical treatment of the cervical spine. * Prior cervical fusion * Evidence of severe cervical spinal deformity based on Ames classification: C2-C7 SVA \> 8cm, Horizontal Gaze \< -10 or \> 25, T1S-CL \> 20, myelopathy (JOA score \<10) or severe adult spinal deformity based on SRS-Schwab classification (PI-LL \> 20, PT \>30, SVA \> 90 mm) * Undergoing simultaneous treatment for thoracolumbar spine related diagnoses at the time of enrollment History of any spinal surgery within the last 6 months * Patients with neck pain attributable to trauma, idiopathic deformity, neoplasm, osteoporosis, or other medical condition. * Unlikely to comply with the follow-up evaluation schedule * Subject has recent history of chemical substance dependency that may impact the outcome or study participation * Subject has a significant psychosocial disturbance or psychiatric history that may impact the outcome or study participation including a DRAM score over 33 * Active infection * Systemic infection (AIDS, HIV, or active hepatitis) * Active litigation * Presence of inflammatory spinal disease (e.g. chronic autoimmune conditions, ankylosing spondylitis, DISH, Rheumatoid Arthritis) * Concurrent Spinal or pelvic fracture