Six randomized controlled trials (n=1,603) comparing artificial total disc replacement and lumbar fusion in patients with lumbar degenerative disc disease were included in this meta-analysis. Pooled data at the 2-year follow-up revealed that artificial total disc replacements (TDR) yielded significantly improved pain and disability compared to lumbar fusion, with no significant difference in safety and blood loss. Furthermore, operating time was significantly lower in the TDR group when compared to anterior lumbar fusion, but not when compared to posterior lumbar fusion.