93 patients, with mono or bi-level cervical disc symptomatic disease and upon failure of conservative treatment, were randomized to undergo total disc arthroplasty (TDA) or anterior cervical discectomy and fusion (ACDF). Primary Outcome Measures were Visual Analogue Score (VAS), Neck Disability Index and Radiographic Assessment were made at different time points until 48 months. Both the ACDF and TDA procedures were found to be equivalent for rendering pain relief in both mono and bi level disc disease and had equivalent risks for inducing adjacent segment degeneration. Interestingly, it was observed that patients with concurrent degenerative disc disease of the lumbar spine had greater likelihood of developing adjacent segment degeneration.