Total disc replacement (TDR) is an innovative procedure that has gained traction in spine surgery. A large amount of data in the literature report on the short-term outcomes of TDR surgery favorably. However, surgeons remain reluctant to opt for TDR surgery due to uncertainty of long-term outcomes. Recently, long term data regarding TDR surgery has become available, with some studies showing superior outcomes to fusion surgery. The goal of this review is to synthesize and clinically contextualize the recent literature on TDR surgery. This article also provides brief discussion of the biggest challenges currently facing disc arthroplasties and the ways in which they are being tackled.