Transpedicle screw fixation of the cervical spine

The use of posterior cervical spine fixation has become increasingly popula r in recent years. Dissatisfaction with lateral mass fixation, especially a t the cervicothoracic junction, has led spine surgeons to use cervical pedi cle 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 t he 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 th e surgeon in the placement of a pedicle screw has raised legitimate concern s as to whether transpedicle fixation can be applied without significant ne urovascular complications. The emergence of computer assisted image guidanc e systems may be implemented in the operative protocol to improve the accur ate placement of a pedicle screw. The indications for placement of a pedicl e screw in the cervical spine are beginning to evolve. Only surgeons experi enced in transpedicle screw fixation and surgery of the cervical spine shou ld perform this method of instrumentation.