Objective To evaluate differences of clinical effects between cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) for single symptomatic single-level cervical degenerative disc disease. Methods Randomized controlled trials (RCTs) from the Cochrane Library Central Register of Controlled Trials (Issue 1, 2009), MEDLINE (2000 to May 2009), EMbase (2000 to May 2009), Ovid (2000 to May 2009), CBM (2000 to May 2009) and CNKI (2000 to May 2009) were electronically searched. Additionally, six relevant journals were handsearched to identify RCTs about comparison of TDR and ACDF in the treatment of single-level cervical degenerative disc disease. All RCTs demonstrating these issues were included. RevMan 5.0 software was used for meta-analyses. Results Six RCTs involving 1 340 patients were included. The results of meta-analyses indicated that there were significant differences between the two groups in neurological success (RR=1.06, 95%CI 1.02 to 1.11, P=0.003), secondary surgical procedures (RR=0.30, 95%CI 0.17 to 0.53, Plt;0.0001) and overall success (RR=1.13, 95%CI 1.06 to 1.22, P=0.0006). However, there were no significant differences in Neck Disability Index (NDI) scores (WMD=1.53, 95%CI –0.55 to 3.61, P=0.15), neck pain scores (WMD= –2.87, 95%CI 7.75 to 1.81, P=0.23), arm pain scores (WMD= –0.7, 95%CI –0.86 to –0.54, P=0.48), radiography success (RR=0.96, 95%CI 0.92 to 1.01, P=0.11), and postoperative complications (RR=0.79, 95%CI 0.49 to 1.28, P=0.34) between the two groups. Conclusion The evidence indicates that compared with ACDF, TDR could improve neurological status, reduce secondary surgical procedures and promote overall success for single-level cervical degenerative disc disease, but there are no significant differences in postoperative NDI, neck and arm pain scores, radiography success, and complications.