Thirteen randomized clinical trials including 2,963 patients with cervical degenerative disc disease were included in this systematic review and meta-analysis comparing cervical arthroplasty vs. anterior cervical arthrodesis. Pooled outcomes of interest included superior adjacent syndrome rate, reoperation rate, adverse event rate, radicular pain, neck disability index, and SF-36 physical and mental components. The pooled results indicated that cervical arthroplasty had a significantly lower rate of superior adjacent syndrome and reoperation, less radicular pain, and better neck disability index and SF-36 physical scores. No significant differences were found in inferior adjacent syndrome rate, adverse event rate, neck pain, or SF-36 mental scores. The main findings suggest that cervical arthroplasty offers advantages in reducing superior adjacent syndrome and reoperation rates compared to anterior cervical arthrodesis.