Anterior cervical spine fusion remains a mainstay of treatment for spinal instability and deformity. Rates of fusion vary from 5 to 40%. Corticocancellous bone grafts and long iliac bone grafts aid in intervertebral fusion, however, in difficult cervical spine arthrodesis cases such as infection, radiation, previous or multilevel repair, the likelihood of fusion decreases with these nonvascularized bone grafts. Vascularized bone grafts such as the fibula have increased compressive as well as torsional strength compared to iliac crest or rib, provide faster biomechanical stability and faster rates of incorporation from 3 to 5 months. Six patients underwent anterior cervical spine arthrodesis with vascularized fibula graft fusion. 5 were male and one female. Mean age was 59.3 years. Etiology ranged included osteomyelitis, failed arthrodesis, cancer resection, and radiation. The fibula graft was harvested in standard fashion and plated by the neurosurgeon. The external carotid and internal jugular vein were most often the target vessels. Results revealed one intraoperative death secondary to blood loss resulting from the spinal surgery and one fibular graft thrombosis. The patient with the thrombosed graft received an immediate reconstruction with a second vascularized fibula graft without postoperative complications. Follow up ranged from 6-12 months. Bone scans revealed successful fusion at 3 months in five of the patients. No long term complications were found at the donor site or the cervical spine. Vascularized fibular grafts can be an effective and reliable method of fusion for difficult spinal arthrodesis. Because of the high morbidity associated with these spinal surgeries, vascularized fibular grafts should be reserved for failed spinal arthrodesis, radiated or infected spines, or multilevel fusions