A free vascularized fibular graft with microvascular anastomoses was applied to six clinical cases of anterior cervical fusion for cervical spondylosis with myelopathy (two patients) and ossification of the posterior longitudinal ligament with myelopathy in four. The numbers of levels fused were three in five patients, and two in one. Their follow-up period ranged from 14 to 42 months (mean, 26 months). Union of the graft occurred between 2.5 and 5 months (mean, 3.4 months) postoperatively. There were no nonunions nor any serious complications. This technique is indicated for multilevel intervertebral fusion in which the nonunion or delayed union rate with conventional bone grafting may be high.