SUMMARY Cervical disc arthroplasty (CDA) is a motion-preserving technique to replace a cervical disc There is mounting evidence that using CDA to avoid a fusion decreases adjacent-level disease and subsequent reoperation rates The primary contraindication to CDA 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. Therefore, interest in motion-preserving procedures decreased 1980s-1990s: A renewed interest in CDA resurfaced when lumbar disc arthroplasty gained in popularity in Europe 2002: First report on modern CDA appeared with the premise that it would decrease or prevent adjacent segment disease by maintaining motion 2010-present: several randomized controlled trials demonstrated superiority to cervical fusion with regard to: reoperation rates quicker return to work OUTCOMES Benefits and risks benefits potential to preserve motion pseudoarthrosis is less of a concern quicker return to routine activities risks hardware failure with potential paralysis persistent neck pain originating from facets Evidence single-level disease CDA equivalent to fusion in: neurologic improvement patient-reported outcomes CDA superior to fusion in: reoperation rates two-level disease CDA equivalent to fusion in: neurologic improvement patient-reported outcomes CDA superior to fusion in: reoperation rates Indications Indications primary CDA single- and two-level cervical radiculopathy single- and two-level cervical myelopathy revision CDA if performed within 2 weeks, results are equivalent to primary CDA Contraindications significant facet degeneration Preoperative Imaging Radiographs AP and lateral views of the cervical spine CT scan useful to determine positioning and sizing of implants MRI evaluate central and foraminal stenosis Technique Approach anterior approach to cervical spine Biomechanics critical to align center of rotation in both the coronal and sagittal planes especially important in two-level CDA Complications Hardware failure may have catastrophic consequences with retropulsion into the spinal canal