Transpedicle screw fixation of the cervical spine

The use of posterior cervical spine fixation has become increasingly popular in recent years. Dissatisfaction with lateral mass fixation, especially at the cervicothoracic junction, has led spine surgeons to use cervical pedicle screw fixation for reconstruction in numerous cervical spine disorders. The biomechanical advantage of a three-column fixation device implanted to secure an unstable cervical spine has proven to be a valuable tool in the spine surgeon's armamentarium. Successful placement of a pedicle screw in the cervical spine requires a sufficient three-dimensional understanding of pedicle morphology to allow accurate identification of the ideal screw axis. Variability in cadaveric based morphometric measurements used to guide the surgeon in the placement of a pedicle screw has raised legitimate concerns as to whether transpedicle fixation can be applied without significant neurovascular complications. The emergence of computer assisted image guidance systems may be implemented in the operative protocol to improve the accurate placement of a pedicle screw. The indications for placement of a pedicle screw in the cervical spine are beginning to evolve. Only surgeons experienced in transpedicle screw fixation and surgery of the cervical spine should perform this method of instrumentation.