Pedicle screw fixation in the cervical spine.

Area of Science:

• Spine Surgery
• Orthopedic Biomechanics
• Neurosurgery

Background:

• Posterior lateral mass plating is a conventional method for lower cervical spine fixation.
• Pedicle screw fixation is a newer technique offering biomechanical advantages for cervical spine reconstruction.
• The anatomical constraints of the cervical spine present challenges for accurate pedicle screw placement.

Purpose of the Study:

• To evaluate the efficacy and challenges of pedicle screw fixation in the lower cervical spine.
• To compare pedicle screw fixation with traditional posterior lateral mass plating.
• To identify optimal indications and contraindications for cervical pedicle screw use.

Main Methods:

• Review of biomechanical studies supporting cervical pedicle screw use.
• Analysis of technical challenges and complications, particularly pedicle penetration.
• Examination of current clinical acceptance and specific applications of the technique.

Main Results:

• Pedicle screw fixation is technically challenging due to the small size of cervical pedicles.
• Pedicle penetration is the most common complication during screw insertion.
• The technique is accepted at C2 and C7, often in conjunction with plating for occipitocervical or cervicothoracic fixation.

Conclusions:

• Pedicle screw fixation should not be routinely employed at the C3-C6 levels.
• Indications include patients with osteoporotic bone or those requiring rigid fixation unattainable by conventional methods.
• Further research may refine the technique and expand its appropriate applications in cervical spine surgery.