18 ACE Reports were identified from the OrthoEvidence database that evaluated cervical total disc replacement (TDR) in comparison to anterior cervical decompression and fusion (ACDF) at a single cervical level. The included trials consisted of 16 randomized controlled trials (RCTs) and 2 meta-analyses. The results of this review indicate that TDR is a safe and efficacious alternative to ACDF, providing similar pain and disability (NDI) improvements, maintenance or improvement in neurological status, and significantly fewer secondary operations at the index level, while allowing for the superior preservation of range of motion in comparison to fusion. Unfortunately due to a lack of trials reporting long-term follow-up outcomes, this review was unable to determine if this preserved range of motion lead to an overall decreased incidence of adjacent level cervical disc disease. Reoperations at adjacent segments were not significantly different between TDR and ACDF. The findings of this review highlighted the need for larger randomized trials to definitively conclude if TDR can provide superior disability and pain outcomes compared to ACDF at both short-term and long-term follow-up periods. Additionally, the necessity for uniform outcome reporting was also emphasized.