SUMMARY Cervical Disc Arthroplasty is a motion preserving technique that has shown to be equivalent, and superior in two level disease, to cervical fusion. There is mounting evidence that by avoiding a fusion, adjacent level disease and subsequent reoperation rates, are decreased. Primary contraindication is advanced degenerative disease of the facets with associated neck pain. History 1966: Fernström first implanted a stainless steel ball bearing in the cervical spine but reported unacceptable rates of device-related complications. at that time, ACDF was gaining popularity with reports of great clinical success and therefore interest in motion preserving procedures decreased. 1980-90s: a renewed interest in cervical ADR resurfaced when lumbar disk arthroplasty gained in popularity use in Europe. 2002: first report on modern cervical ADR appeared with the premise that it would decrease or prevent adjacent segment disease by maintaining motion 2010 to present several RCT showing superiority to cervical fusion with regard to reoperation rate quicker return to work OUTCOMES Pros and cons benefit potential to preserve motion pseudoarthrosis not a concern quicker return to routine activities risks hardware failure with potential paralysis persistent neck pain from pain originating from facets Evidence single-level disease CDA equivalent to fusion in neurologic improvement patient reported outcomes CDA superior to fusion in reoperation rate two-level disease CDA equivalent to fusion in neurologic improvement patient reported outcomes CDA superior to reoperation rates Indications Indications primary CDA single and double level cervical radiculopathy single and double level cervical myelopathy revision CDA if performed within 2 weeks results are equivalent to revisoin Contraindications significant facet degeneration Preoperative Imaging Radiographs AP and lateral of cervical spine CT scan useful to determine positioning and sizing of THA MRI required to evaluate central and foraminal stenosis. Technique Approach anterior approach to cervical spine Biomechanics critical to align center of rotation in both coronal and saggital plane especially important in two level CDA Complications Hardware failure may have catastrophic consequece in retropulsion into spinal canal