Cervical disc replacement versus anterior cervical discectomy and fusion using stand-alone cage for degenerative cervical spondylosis: a systematic review and meta-analysis based on randomized controlled trials.

Our objective was to compare the efficacy and safety of cervical disc replacement (CDR) versus anterior cervical discectomy and fusion using stand-alone cage (SAC) in single-level degenerative cervical spondylosis (DCS). We conducted a comprehensive search across four databases for articles comparing CDR with SAC in the management of DCS from inception until August 8, 2025. Meta-analysis was performed using Stata17. Seven studies were included in this analysis. In treating single-level DCS, CDR significantly demonstrated longer operative time [WMD = 26.94, 95% CI (17.88, 35.99), p < 0.01], increased blood loss [WMD = 34.94, 95% CI (15.73, 54.15), p < 0.01], higher visual analog scale scores for neck pain [WMD = 0.32, 95% CI (0.08, 0.57), p = 0.01] and arm pain [WMD = 1.05, 95% CI (0.82, 1.28), p < 0.01], as well as lower 36-item Short-Form Health Survey scores [WMD = -1.26, 95% CI (-2.04, -0.49), p < 0.01]at final follow-up compared to SAC. However, there were no significant differences between CDR and SAC regarding neck disability index, cervical curvature, reoperation rates, adverse event rates, or adjacent segment degeneration rates at last follow-up (p > 0.05). In conclusion, SAC performs better than CDR in the treatment of DCS, in terms of shortening operation time, reducing blood loss, relieving pain, and improving quality of life.