Spinal reconstruction using a cervical pedicle screw system

Although the cervical pedicle screw system is considered the most effective instrumentation for posterior cervical spine surgery, reports on clinical application are limited because of the unresolved and inherent risk of neurovascular complications. The purpose of this study is to retrospectively evaluate the accuracy of placement and clinical effectiveness of the cervical pedicle screw. The cases of 26 patients were investigated. The average followup was 20 months. All but one patient had simultaneous decompression and fusion of various extent. In these cases, screw placement, alignment of the fused segment, fusion rate, neurologic improvement, and complications were assessed. Using an image intensifier, 134 screws were inserted. Five screws (3.7%) completely perforated and 10 (7.4%) partially perforated. The complete perforations occurred in the first 10 patients. Except for two patients with metastasis, bony union was obtained in all patients without loss of correction. Neurologic impairment also was improved in all patients, and no complications associated with the cervical pedicle screw were seen. Clinical results of the cervical pedicle screw system were excellent with few complications. However, there is the possibility of screw perforation, which could cause neurovascular complications. Increased accuracy of screw insertion is needed to make this instrumentation safer.