Cervical Disc Arthroplasty vs. Anterior Cervical Discectomy and Fusion: A Narrative Review of Long-Term Outcomes

Abstract

Anterior cervical discectomy and fusion (ACDF) has been the default surgical treatment for symptomatic cervical degenerative disc disease for decades, but concern about accelerated degeneration at the segments adjacent to a fused level has driven three decades of interest in motion-preserving alternatives. Cervical disc arthroplasty (CDA) was designed to address this concern by replacing, rather than fusing, the diseased disc. Early meta-analyses limited to two-year follow-up produced a mixed picture, but a growing body of long-term randomized controlled trial data — most recently synthesized in an August 2025 meta-analysis restricted to trials with at least four years of follow-up — now paints a more consistently favorable picture for CDA on pain, disability, neurological recovery, reoperation, and adjacent segment degeneration. This review walks through what the long-term evidence shows, why earlier short-term reviews were more equivocal, and where genuine uncertainty remains.