Reconstruction of the Subaxial Cervical Spine Using Pedicle Screw Instrumentation

Study Design. Review article. Objective. To review the indications, detailed techniques, and complications of cervical pedicle screw fixation procedure. Summary of Background Data. Although screw insertion into the cervical pedicles has been considered too risky for the neurovascular structures except C2 and C7, biomechanical studies revealed a superior stabilizing effect of pedicle screw fixation in the cervical spine to other fixation procedures including lateral mass screw fixation. In addition, several investigators reported superior reconstructive results of unstable cervical spine. Methods. A literature review and review of the authors' experience in the treatment of the patients with unstable cervical spine and/or cervical spinal deformities using cervical pedicle screw fixation procedure. Results. Pedicle screw fixation is biomechanically most reliable for reconstruction of the cervical spine in various kinds of disorders. Previously reported articles revealed that pedicle screw fixation is useful for reconstruction of unstable cervical spine and correction of cervical deformities. Neurovascular complication by this procedure cannot be completely eliminated; however, it can be minimized by sufficient preoperative imaging studies and strict control of screw placement during surgery. Modern technology of computer navigation system and newly developing aiming devices can be expected to increase the accuracy of screw placement. Conclusion. Pedicle screw provides excellent 3-dimensional fixations and is a useful procedure for reconstruction of the cervical spine in various kinds of disorders. Possible neurovascular complication can be minimized by sufficient preoperative imaging studies and strict control of screw placement during surgery.