10 randomized controlled trials with outcomes reported in 13 publications were included in this meta-analysis and systematic review examining the use of anterior cervical decompression and fusion (ACDF) or cervical disc arthroplasty (CDA) in the treatment of symptomatic cervical degeneration. Included trials featured follow-up data in the short-term (1-3 years) and intermediate-term (4-5 years). Pooled analyses indicated that functional and neurological recovery was significantly better in the short- and mid-terms for CDA-treated patients, along with pain in the mid-term. Fewer index level reoperations and surgical complications were noted with CDA. Adjacent level degeneration was similar between treatments.