Fifteen randomized controlled trials with a total of 2677 cervical degenerative disease patients were included in this meta-analysis comparing anterior cervical discectomy and fusion (ACDF; n=1237) or total disc replacement (TDR; n=1440). The primary outcomes of interest included the overall success rate and the incidence of adverse events. Other outcomes of interest included the neck disability index (NDI), NDI success rate, neurological success rate, reoperation rate, and patient satisfaction. All outcomes were assessed at 2 years follow-up and long-term (24-84 months) follow-up. Pooled results revealed that overall success rate was statistically significantly in favour of the ACDF group at both 2 years and long term follow up. However, pooled results revealed that patient satisfaction, incidence of secondary surgery, and neurological success rate were statistically significantly in favour of the TDR group at both timepoints. NDI success rate was not statistically significantly different at 2-year follow-up (p=0.07), but was statistically significantly in favour of the TDR at long-term follow-up (p=0.001).