Outcome of cervical cases operated with posterior cervical pedicle screw placement: a single-center retrospective study

Cervical pedicle screws offer biomechanical advantages over other stabilization systems. However, their placement carries a relatively high risk of vascular or neurological injury due to individual differences and the complex structure of the cervical spine. Therefore, understanding patient-specific anatomy is crucial for the safe and accurate placement of pedicle screws. In this study, we present our single-center case series over a seven-year period involving cervical pedicle screw placement in subaxial cases. We retrospectively analyzed patients who underwent cervical subaxial pedicle screw placement between 2017 and 2024. A freehand surgical technique was employed, using a mini-laminotomy approach to ensure safe screw placement. During the procedure, the medial, superior, and inferior borders of the pedicle were palpated. A total of 70 cases were analyzed retrospectively. Fifty patients were male, and 20 were female. The patients ranged in age from 20 to 89 years (median age: 64 years). Fifty-seven patients (81.5%) had cervical stenosis as the surgical indication. Of the remaining cases, 11 patients had fractures and two had tumors. Among the 468 pedicle screws placed, 434 were graded as 0-1. The correct placement rate was 92.7%. Thirty-four screws were malpositioned (grade 2-3), representing a rate of 7.3%. In our case series, the accuracy of cervical subaxial pedicle screw placement was high. We believe that achieving this level of accuracy requires a strong understanding of anatomy, three-dimensional spatial awareness, and surgical experience.