Three cervical disc arthroplasty devices are currently approved for patient care in the United States. There are different kinematic designs (ball and socket, ball and trough, and mobile center core) and different bearing couples (stainless steel metal on metal, cobalt-chromium on polyethylene, and titanium on polycarbonate-polyurethane). Other designs with cobalt-chromium metal-on-metal bearing surfaces are also being investigated in pivotal clinical trials. No clinical differences are apparent between these devices at this time. The four and five-year results of randomized clinical trials comparing arthrodesis with arthroplasty after decompression for the treatment of single-level cervical disease have shown equal or better results following arthroplasty as compared with arthrodesis in terms of overall clinical success, pain, and functional improvement, and the results have been stable over time. Revision rates of 2% to 5% have been seen following arthroplasty, and in these trials no device failures or wear-associated complications have been observed. Pooled data indicate that the rates of reoperation are significantly higher following arthrodesis, at both the index and adjacent levels. Two cases of apparent metal hypersensitivity causing a pseudotumor with symptomatic spinal cord compression following the placement of a cobalt-chromium metal-on-metal cervical prosthesis have been reported. These cases were similar to the pseudotumor reactions seen in some patients following metal-on-metal total hip arthroplasty.