19 randomized controlled trials were included in this systematic review and meta-analysis comparing outcomes following cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF). CDA resulted in lower Neck Disability Index scores and greater rates of at least a minimum 15-point improvement on the NDI, lower pain scores, higher range of motion at the operated level, lower rates of secondary surgery at the operated level in the short- and mid-term, lower rates of secondary surgery at adjacent levels in the short-term, and higher rate of overall success (min. 15-pt improvement in NDI, improvement or maintenance of neurological status, and no experience of severe adverse event) when compared to ACDF.