The cervical pedicles are short, stout bony pillars connecting the vertebral body to the posterior elements, forming the lateral wall of the spinal canal and the superior and inferior walls of the intervertebral foramina. The cervical pedicles are significantly smaller than lumbar pedicles and have a more complex trajectory, making pedicle screw placement technically demanding.
Cervical pedicle screws provide the strongest fixation in posterior cervical instrumentation but carry greater risk of neurological injury than lateral mass screws due to the small pedicle dimensions (5-7 mm width at C3-C6, 7-8 mm at C7). CT-based surgical planning is mandatory. The vertebral artery runs in the transverse foramen just lateral to the pedicle at C3-C6. Pedicle cortex breach medially risks spinal cord injury; breach laterally risks nerve root or vertebral artery injury.
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