The decision whether to use allograft or autograft in ventral cervical fusions has been widely discussed. The literature includes several prospective randomized trials. Extensive clinical evidence indicates that autograft use results in increased arthrodesis rates and less graft collapse. However, autograft harvest has a substantial morbidity rate. Allografts avoid the morbidity associated with autograft harvest but result in decreased arthrodesis rates and increased graft collapse rates. The decreased arthrodesis rate associated with allografts becomes more significant in multilevel surgery and in patients who smoke. The introduction and use of ventral cervical plates have made allograft use more attractive by increasing arthrodesis rates and decreasing graft collapse.