OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is a popular procedure for patients with cervical spondylotic myelopathy, but few studies reported the clinical outcomes of cervical local bone graft with a PEEK cage used in it. This retrospective study was performed to compare the clinical and radiological outcomes of using local bone graft with a PEEK cage versus iliac bone graft in ACDF. METHODS A total of 60 consecutive patients who underwent ACDF were evaluated from January 2010 to January 2013. Twenty-nine patients received ACDF with a PEEK cage combined with cervical local bone graft (local bone group) and 31 patients received ACDF with autologous tricortical iliac bone graft (iliac bone group). The intraoperative and perioperative complications of both groups were recorded. Preoperative and postoperative radiographs were taken to calculate the ratio of interbody height to the disc height and the interbody bony fusion rate. The Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) were used to estimate postoperative clinical outcomes. RESULTS The mean follow-up duration was 25.0±3.8months in the local bone group and 24.4±3.4months in the iliac bone group (P=0.56). Although there was no significant difference between the two groups in terms of blood loss (P=0.17), the length of surgery was significantly less in the local bone group comparing with that of iliac bone group (P=0.01). Postoperatively, VAS scores were significantly decreased, and JOA scores were improved in both groups. However, no statistically significant differences were found between the two groups at final follow up (P=0.45 and P=0.93). The disc space height and segmental interbody angle at the surgical segment were greater in local bone group than those in the iliac bone group (P<0.001 and P<0.001). The fusion rates were 93.1% in local bone group and 90.3% in the iliac bone group at last follow up (P=0.70). Perioperative complication rates in local bone group and iliac bone groups were 6.8% and 29%, respectively (P=0.04). CONCLUSIONS Based on this study, patients receiving ACDF with local bone graft combined with a PEEK cage had significant shorter operation time, lower perioperative complications rate, and better radiological results comparing with those with an iliac bone graft alone. It seems that the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft for ACDF.