Cervical spondylosis, common among people older than 50 years, may produce symptoms of cervical radiculopathy, myelopathy, or both. When patients with degenerative cervical disease require surgery, an anterior decompression of the neural elements and reconstruction of the anterior column with allograft or autograft is common. Allograft incorporates more slowly and less completely than autogenous bone graft, although harvest of autograft from the anterior iliac crest or the middle 1/3 of the fibula may be associated with postoperative morbidity. Overall, higher rates of fusion have been reported with autograft than allograft. However, similar fusion rates have been reported among nonsmokers having single-level anterior cervical interbody fusions. For patients requiring multilevel reconstruction surgery, fusion rates of approximately 100% have been achieved using autogenous strut grafts from the iliac crest and fibula, with a lower rate of incorporation for fibula allograft. The potential for a patient with a nonunion requiring additional operative treatment must be weighed against the potential for graft-related complications when choosing between autograft and allograft for anterior cervical reconstruction.