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GATA Haydarpaşa Teaching Hospital, Department of Neurosurgery, İstanbul, Turkey It is generally believed that the rate of pseudoarthrosis rises as the number of operative levels of anterior cervical discectomy and fusion increases. This retrospective study evaluated bone union status in 13 patients who underwent three-Ievel anterior cervical discectomy and fusion with the Cloward technique. No allografts or internal fixators were used in any of the procedures. Pseudoarthrosis developed in four patients, each with one level affected, and three of these individuals were cigarette smokers. None of the 13 patients needed subsequent surgery, and there were no major postoperative complications. The Cloward technique is effective for three-Ievel anterior cervical discectomy and fusion, but the associated 30% pseudoarthrosis rate in the group of patients in this study was unacceptable. In all cases, the cervical level that developed pseudoarthrosis was the lowest motion segment that had been operated. Keywords : Anterior cervical discectomy and fusion, autograft, internal fixation, pseudoarthrosis