Fourteen randomized controlled trials were included in this meta-analysis and systematic review, which aimed to compare outcomes between total disc replacement (TDR) and anterior cervical discectomy and fusion for the management of degenerative cervical disc disease. Pooled results of a composite endpoint for overall success and neurological success significantly favoured TDR at short- (2-year) and mid-term (4- to 7-year) follow-up. In systematic review, results on Neck Disability Index, VAS neck pain, and VAS arm pain scores were mixed among studies, though individual results either significantly favoured TDR or demonstrated no significant difference between groups; no study significantly favoured ACDF over TDR. Of 5 studies which reported the outcome, the majority significantly favoured TDR for reduced adjacent segment degeneration and both short- and mid-term follow-up