Background: Anterior cervical decompression and fusion (ACDF) is a common procedure in neurosurgical practice to manage the cervical cord/nerve roots compression by intervertebral disk herniation / osteophytic formation. However, cervical total disk replacement (TDR) progressively became a feasible alternative to ACDF in surgical practice. This procedure is thought to have many advantages compared to classical ACDF. The aim of the present study is to investigate if TDR is superior as outcome measures than ACDF, by reviewing the published data available to date.Methods: We searched several electronic databases up to December 2010. Outcomes sought includes pain relief, functional capacity, quality of life, adjacent disk disease, secondary surgeries, kinematics/range of motion, return to work, adverse events, potential candidacy rate for surgery. We selected mainly randomized controlled trials.Results: Compared to ACDF, TDR has superior or equal clinical outcomes, a lower incidence of adjacent disc disease (radiological +/- clinical), lower rate of secondary revision surgeries, supplemental fixation or adjacent segment reoperation, superior spine kinematics, which is maintained over time, earlier return to work. On the other hand, the presented studies have shown that TDR exposes the patients to more frequent postoperative events and have an inferior candidacy rate compared to ACDF. We did not have access to straight –forward economic data, but TDR seems to be more costly than ACDF.Conclusions: TDR already represents a well-established technique in the armamentarium to manage the cervical disc herniation, a method required to be handled by any surgeon involved in spinal care
