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Thirteen patients with fractures and/or dislocations of the middle and lower cervical spine were treated by transpedicular screw fixation using the Steffee variable screw placement system. Postoperative immobilization was either not used or simplified to short-term use of a soft neck collar. Recovery of nerve function and correction of kyphotic and/or translational deformities were satisfactory. All patients had solid fusion without loss of correction at the latest follow-up. There were no neurovascular complications. It was concluded that transpedicular screw fixation is as strong a fixation procedure for the cervical spine as it is for the thoracic and lumbar spine. This surgical procedure is associated with some risks of major neurovascular injuries; however, safety is adequate if the procedure is performed by experienced surgeons using meticulous surgical techniques.