Forty-seven patients with single-level cervical radiculopathy were randomized to receive either BRYAN CDA (cervical disk arthroplasty; n=22) or ACDF (anterior cervical discectomy and fusion; n=25) in a prospective, randomized, controlled trial conducted as a Food and Drug Administration Investigational Device Exemption trial. The primary outcomes of interest included visual analog scales (VAS) for neck and arm pain, neck disability index (NDI), and reoperation rates. The follow-up rate was 91.3%. Both groups demonstrated significantly improved NDI, VAS arm pain, and VAS neck pain scores at 20 years compared to preoperative scores. However, there were no significant differences between CDA and ACDF groups at 20 years for NDI, VAS arm pain, and VAS neck pain scores. Reoperations were reported in 41.7% of ACDF patients and 10.0% of CDA patients. Both CDA and ACDF were effective in treating cervical radiculopathy, with CDA showing lower reoperation rates.