Nine randomized controlled trials (RCTs) including a total of 2,664 patients were included in this systematic review comparing cervical disc arthroplasty (CDA) (n=1,464) vs. anterior cervical discectomy with fusion (ACDF) (n=1,200). All included RCTs had a minimum of 7 years of follow-up. The outcomes of interest included overall success rate, functional and pain scores, range of motion, adjacent segment syndrome, adverse events, and reoperation. The pooled analyses found that CDA had a significantly better overall success rate, better neck function, less arm pain, better physical quality of life and range of motion, lower rates of adjacent segment syndrome, and a lower rate of reoperation compared to ACDF, suggesting that it could be a safe and effective alternative for the treatment of cervical disc diseases.