Posterior screw fixation in the subaxial cervical spine: a technique and literature review

Posterior cervical spine fixation is a key component in achieving spinal arthrodesis for treating various cervical spine pathologies including neoplastic, inflammatory, traumatic and degenerative diseases. Historically, various wiring techniques had played major roles in posterior cervical spine fixation. Today, posterior cervical screw fixation is utilized by most spine surgeons instead of wiring for its superior biomechanical strength. A review of lateral mass, pedicle, intralaminar and transfacet screw fixation techniques in the subaxial cervical spine is presented in a detailed fashion. A comparison among different posterior cervical subaxial fixation techniques is also included. Although the safety of freehand techniques was demonstrated in the majority of the existing studies, real-time navigation is becoming increasingly utilized for cervical screw insertion, especially for cervical pedicle screws, where the freehand technique is technically demanding and may carry a higher risk of neurovascular injury. Several different posterior screw fixation techniques exist for the subaxial cervical spine with generally low complication rate. Spine surgeons should be familiar with these techniques and choose the optimal technique based on each patient's individual anatomy and surgical needs.