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BACKGROUND Cervical artificial disc replacement (C-ADR) has been proposed as an alternative to anterior cervical discectomy and fusion for patients with symptomatic cervical degenerative disc disease.However, the correlation ofbetween the outcome after C-ADR againstand a variety of factors are still unclear.OBJECTIVE The aim of this systematic review is tTo identify the factors that may affect the outcome in C-ADR, and provide the pooled results of postoperative heterotopic ossification (HO) incidence and surgery rate for adjacent segment disease (ASD).METHODS We systematically searched Ovid-Medline and Ovid-EMBASE from 2000 to September 2012.Two independent reviewers screened and selected the primary records.Eleven questions were asked previously regardingabout the effect of patient selection issues, motion technology and sagittal alignment issues on outcomes.Studies in which where answers were found were included for analysis.RESULTS We included 45 studies, including 10 level Ⅰ, 2 level Ⅱ, 1 level Ⅲ, and 32 level ⅣV studies.Results showed that surgical level, patient s age, prior surgery, implanted segment range of motion, postoperative HO, postoperative cervical kyphosis, postoperative disc height had no effect on outcome.Outcomes No difference was found between soft-disc herniation and spondylosis, between radiculopathy and myelopathy had no difference.The available evidence for the question of single versus multilevel surgery is conflicting.The overall incidences of postoperative grade 1-4 HO and grade 3-4 HO in the implanted level were 51.6% and 14.8%, respectively, and the overall surgery rate for ASD was 3.0%.CONCLUSIONS The available evidence showed that most of the pre-selected factors had no effect on the outcome in C-ADR, and the incidence of HO and surgery rate for ASD are acceptable.Because of limited studies for some questions, further studies addressing these factors are still needed.