Anatomic considerations in posterior plating of the cervical spine

We evaluated the anatomic structures at risk during posterior plating of the cervical spine and outlined a safe technique for screw insertion. Three cadaveric specimens were evaluated anatomically and radiographically. Screws and wires were inserted into the articular masses at different locations and angulations. The relationship of the neurovascular structures to the screws and wires was noted. To avoid injury to the nerve roots, vertebral artery, and spinal cord, the screw should be placed in the center of the articular masses perpendicular to the vertebral plane with 15 degrees lateral angulation.