Cervical fixation in the elderly

Posterior fixation of the cervical spine is a common procedure performed for many conditions including trauma, degenerative conditions, deformities, infection, neoplasms, and congenital malformations. Unlike thoracolumbar spine fixation, cervical fixation should consider the risk of vertebral artery injury in addition to the stability of the fixation and spinal cord/nerve root injury. Although lateral mass screw fixation is the most common type of cervical fixation, other options including pedicle screws and translaminar screws could be utilized. Each technique comes with its own advantages and risk of complications to the neural structures, vertebral artery, and fixation failure. However, these risks can be elevated in the elderly population with 1) decreased bone density 2) degenerative changes to the spine and 3) tortuosity of vertebral artery.