The use of anterior cervical discectomy and fusion (ACDF) is a common procedure used to treat those who suffer from degenerative disc disease (DDD) of the cervical spine which may result in spondylolisthesis, spinal stenosis, disc herniation, nerve root and/or cord compression. ACDF is regularly used for the fusion of one to four cervical spine levels; however, the literature documenting the fusion of 5 or 6 levels is surprisingly lacking. In this retrospective review of our case series, we document two 5-level and two 6-level ACDF in elderly patients using custom made titanium fusion plates and patellar allograft bone for interbody placement without posterior fixation. The documentation of these long anterior constructs without supplemental posterior fixation or the use of a halo vest apparatus, but a simple neck collar for three months, is an important contribution to the literature illustrating that with utilization of appropriate technique, a high number of levels can be safely fused in the elderly patients necessitating this particular procedure.