Anterior cervical discectomy and fusion (ACDF) has been a very successful procedure in the management of cervical radiculopathy and myelopathy. Concerns with adjacent segment disease and the desire to preserve physiological motion have led to technological and clinical efforts for cervical disc arthroplasty. The suggested move to cervical disc replacement has led to this latter procedure being one of the most scrutinised surgical treatments in the twenty-first century. Short- and medium-term prospective randomised clinical trials and systematic reviews show cervical disc replacement to be at least as good as ACDF as regards the clinical outcomes in the management of degenerative cervical spondylosis. This is logical since the neural decompression procedure is essentially the same. However, the rationale for arthroplasty over arthrodesis has been built on two main proposed roles: the preservation of segmental motion and the prevention of adjacent segment disease. Whilst results thus far show that this first role seems to be achieved, its clinical significance is as yet unproven; the second is so far not proven. In addition, the long-term fate of the implants is also unknown. Long-term safety and efficacy, therefore, still await further clinical studies.