Depression and back pain are both leading causes of global disability and frequently coexist in patients undergoing spine surgery, where mental health status has been linked to postoperative outcomes. This retrospective analysis examines the relationship between preoperative depressive symptoms, measured using the Zung Self-Rating Depression Scale (SDS), and pain outcomes following spinal surgery. Patients were categorized into normal, mildly depressed, moderately depressed, and severely depressed groups based on validated SDS thresholds. Pain was assessed using numeric rating scales across four anatomic regions—back, leg, neck, and arm—both preoperatively and at six-month follow-up. Patients with mild to severe depression consistently reported higher pain scores across all regions compared to those in the normal range prior to surgery. Importantly, elevated pain scores persisted at six months postoperatively, suggesting that depressive symptoms may influence both baseline pain perception and recovery trajectories. These findings highlight significant variability in surgical benefit among patients with differing mental health profiles and reinforce the importance of incorporating psychological assessment into preoperative evaluation. Ongoing data collection aims to expand representation in higher depression categories and explore outcomes across additional spine surgery types. Integrating mental health screening and targeted perioperative support may improve postoperative pain outcomes and overall patient satisfaction following spinal surgery.