The visual analogue scale (VAS) and the neck disability index (NDI) have historically been used to assess neck pain and disability. There aren’t many studies that look at how patients with neck pain/disability, myelopathy, radiculopathy, and both respond differently to a treatment. Through a retrospective analysis of a prospective surgical database from 2013 to 2020, patients were found. VAS neck and arm, NDI, 12-Item Short Form physical composite score (SF-12 PCS), Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF), and Patient Health Questionnaire 9  (PHQ-9) were among the patient-reported outcome measures (PROMs) that were gathered. PROMs were gathered both before surgery and up to a year later. Preoperative symptom severity was used to group patients into the following categories: high VAS arm (>7), high NDI (>55), high VAS arm and NDI, and moderate symptoms. The effect of preoperative symptom severity on PROM scores and achievement of minimum clinically important difference (MCID), respectively, was examined using logistic regression and linear regression. There was 187 patients total, 98 of whom did not have high VAS or NDI (moderate group), 14 had high NDI, 46 had high VAS, and 29 had both high NDI and VAS. Greater symptom severity was a significant postoperative predictor of VAS neck (all timepoints; P≤0.002, all), VAS arm (6 weeks; P=0.007), NDI (6 weeks to 6 months; P<0.001, all), SF-12 PCS (6 months; P=0.004), PROMIS PF (six weeks; P=0.007), and PHQ-9 (6 weeks to 6 months; P<0.001, all). With the exception of 1-year, the mean postoperative improvement varied between the four severity groups for the VAS arm, NDI, and VAS neck (P≤0.002, all). Overall MCID achievement rates were significantly greater among higher symptom severity groups across the VAS arm and NDI (P≤0.003, both). According to the severity of the symptoms, NDI, VAS neck, and VAS arm PROM improvement and MCID achievement varied.