STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the efficiency of titanium mesh cylinder as an anterior strut in reconstructive spinal surgery. SUMMARY OF LITERATURE REVIEW: Biomechanically, 80 to 85% of the axial forces on the upright spine are distributed through the anterior column. Reconstruction of the anterior column using load sharing construct is essential for normal spinal biomechanics in various anterior column deficiency conditions. Titanium mesh cylinder as an anterior strut has advantages in these surgical conditions, and may be an effective alternative to strut bone graft. MATERIALS AND METHODS: From October 1993 to May 1998, 22 patients received reconstructive spinal surgery using titanium mesh cylinder-bone graft composite. Average follow up period was 3(1/2)years(range: 1(1/2)to 6 years). 20 of them were male and 2 were female and average age was 45 years(range: 21 to 69 years). The diagnoses were kyphosis/kyphoscoliosis, burst fracture/ fracture-dislocation, revision surgery, tumor, and multiple thoracic HNP. Radiographs were taken preoperatively, postoper-atively at 2 weeks, 4, 6, 9, 12, 18, 24 months, and yearly thereafter, these were read for change of sagittal angle correction, anterior bony fusion, settling of the titanium mesh cylinder-bone graft composite, or instrument failure. RESULTS: Radiologic union between titanium mesh cylinder & vertebra appeared at (1/2)to 1 (1/2)years follow-up period. 81.8%(18 of 22 cases) showed definite bony trabeculation, and 18.2%(4 of 22 cases) showed immature bony trabeculation. Sagittal angle correction loss was measured by average 7.6 .(range: 5 .to 9 .) in 8 of 22 cases, all of which appeared at 4 months to 1 year follow-up period. Correction loss was associated with penetration of spikes of titanium mesh cylinder into endplates of adjacent vertebral bodies until internal rings contact endplates, but was not accompanied with implant failures, dislodgement or migration of titanium mesh cylinder. CONCLUSIONS: Titanium mesh cylinder can be used as a good substitute of anterior strut in combination with rigid spinal fixa-tion in reconstructive spinal surgery.