Purpose <p>The rate of lumbar spine surgeries has increased and the postoperative course is influenced not only by physical but also psychological factors. Patients with pre-existing psychological disorders appear to be more likely to develop anxiety and depression, these factors could negatively affect pain perception, disability, and quality of life. A systematic review and metanalysis were performed to determinate which psychological factors impact on spinal postoperative clinical outcomes and how it can influence postoperative clinical outcomes in patients undergoing spinal surgery.</p> Methods <p>A Systematic literature review was performed on the following databases: PubMed/ MEDLINE, Scopus, Psychinfo and Web of Science on October 2022. The quality of the included studies was assessed using the ROBINS-E tool (Risk Of Bias In Non-randomized Studies - of Exposures). This review was registered at Prospero CRD42022380777. Meta-analysis was performed to compare back pain, leg pain disability, quality of life between the group of patients with psychological issues and control groups as continuous outcomes.</p> Results <p>Of the identified 1756 studies, eventually 13 studies were included with a total of 5364 patients. Our results suggest that patients affected by anxiety and depression report worse back pain (MD 0.40, 95% CI 0.20 to 0.62, <i>p</i> = 0.0001) and disability (MD 9.58 95% CI 2.67 to 16.48, <i>p</i> = 0.007) levels after spine surgery than patients with healthy mental status. Instead quality of life and leg pain don’t show significant differences between the two groups.</p> Conclusion <p>Our findings demonstrate a correlation between presence of mental disease and the worsening of post-surgical clinical outcomes. Anxiety and depressive symptoms can influence pain and disability symptoms during the postoperative phase.</p>