Anterior strut-grafting was used in forty-eight patients to treat structural kyphosis of the thoracic and lumbar spine. Forty patients had a combined anterior and posterior arthrodesis. Kyphosis was corrected from an average of 93 degrees preoperatively to an average of 59 degrees at follow-up. Eight patients underwent anterior cord decompression, five of whom showed improvement of neural function at follow-up. Ten patients had a loss of correction averaging 19 degrees. In four patients a pseudarthrosis developed at the strut graft-vertebral body junction. The strut graft fractured in five of nine patients in whom the graft was four centimeters or more from the apical vertebra. Complications were frequent, but for the most part they were thought to have been preventable. Anterior strut-grafting appears to be a valid and logical technique for managing structural kyphosis.