Objective: Cervical disc degeneration is a common radiographic finding among patients with cervical spine pathology,however there is little literature exploring severity of cervical disc degeneration and postoperative health-related quality of life (HRQOL) outcomes following anterior cervical discectomy and fusion (ACDF). The purpose of this study was to explore the relationship between severity of cervical disc degeneration and postoperative HRQOL outcomes in patients status post 1- and 2-level ACDF.Methods: Patient demographics, case characteristics, and minimum one-year HRQOL outcomes were obtained via SQL query and manual chart reviews. Cervical disc degeneration was graded using a previously established scoring systemincorporating: middle intervertebral disc height loss, anterior osteophyte length, and endplate sclerosis. Statistical analysis was performed with regression to examine the relationship between severity of disc degeneration and patient/clinical outcomes.Results: Of the 211 patients in the final cohort, 27 had mild degeneration, 100 moderate degeneration, and 84 severe degeneration. While all groups demonstrated statically significant improvement in NDI, VAS neck, VAS arm and SF-12 PCS, patients with severe disc degeneration reported significantly more improvement in SF-12 PCS (β:3.6;p=0.01) and VAS Neck (β:-1.1;p=0.01) scores compared with the mild and moderate disc degeneration groups.Conclusions: Our data suggests that ACDF patients suffering from severe disc degeneration preoperatively report the greatest improvement in symptoms and functional status compared to patients with mild and moderate disease.