Operative treatment for cervical spondylotic myelopathy and myeloradiculopathy by anterior decompression produced functional improvement of one grade (Nurick's rating system) in 16 of 21 patients evaluated at 32 months average follow-up period. The best results occurred in patients with symptoms for less than one year and classified as grades I-III. The anterior approach for decompression is preferred because it is directed toward the degenerative structures responsible for cord and root compression. The autogeneic fibula dove-tailed strut graft is favored over an iliac crest bone graft because with multilevel decompression in the cervical spine, it provided structural stability and a high union rate. There were no neurologic complications in this series of 21 cases.