Green development is not only important for realizing a sustainable development strategy, but also a key approach for constructing an ecological civilization and transforming economic development. On the basis the development concept of a coordinated human–earth relationship and the paradigm of the process–pattern mechanism, this research adopted the drivers, pressures, state, impact, and response (DPSIR) model to build a green development level indicator system. The established indicator system is then applied to explore the spatial-temporal patterns and obstacles in the green development of 34 prefectural cities in Northeast China from 2008 to 2017 by the use of the entropy weight TOPSIS model, the obstacle model and the GIS spatial visualization method. There are three main findings. First, during the research period, the spatial evolution of the green development level of cities in Northeast China has gradually shifted from a small gap at an overall low level to a large gap at an overall high level; the spatial pattern of the green development level in these cities is characterized by a decrease from north to south and obvious spatial agglomeration effects. Second, specific findings in this research fail to indicate that the correlation between the economic development level and green development level of cities in Northeast China is entirely positive. That is, cities with higher economic development levels do not necessarily have higher green development levels, while some cities with lower economic development levels did present higher green development levels, which may be related to each region’s resources and environmental carrying capacity. Third, the mechanisms influencing spatial-temporal variation in the green development level of cities in Northeast China are not identical. Among them, resource endowment conditions, economic development status and government investment scale are playing a vital role in changes in the regional green development level, and they are also behind the diverse evolutionary characteristics presented in the different stages of regional green development. For the cities in Northeast China, in the process of promoting green development and to consolidate their existing green development level, efforts should be made to overcome inefficiencies in socioeconomic growth and to continuously enhance ecological protection and environmental governance. Moreover, it is essential to promote incremental increases in the green development level on the basis of the local conditions through the ingestion, absorption and combination of each city’s own characteristics with lessons from the successful experience of different types of cities. In the future, our research should fully consider the role of urbanization, industrial structure, population density, institutional mechanisms, environmental protection supervision, scientific and technological progress and other factors on the green development level in Northeast China and seek an important entry point to achieve regional human–earth coordination.