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This retrospective study was conducted to analyze the clinical results in 45 patients with nontraumatic lesions of the cervical spine treated by pedicle screw fixation.To evaluate the effectiveness of pedicle screw fixation in reconstructive surgery for nontraumatic cervical spinal disorders.Pedicle screw fixation for hangman's fracture of the axis and traumatic lesions of the middle and lower cervical spine has been reported; however, there have been no reports on pedicle screw fixation for nontraumatic lesions of the cervical spine.Forty-five patients with nontraumatic lesions of the cervical spine underwent reconstructive surgery including pedicle screw fixation and fusion. Five patients underwent occipitocervical fixation for the lesion of the upper cervical spine, and one patient underwent separate occipitocervical fixation and cervicothoracic fixation. Cervical or cervicothoracic fixation was performed in 39 patients. Twenty-six of these patients underwent simultaneous laminectomy or laminoplasty. Supplemental anterior surgery was conducted for 15 patients.Solid fusion was obtained in all patients except eight with metastatic vertebral tumors who did not receive bone graft. Correction of kyphosis was adequate. There were no neurovascular complications, except one case of transient radiculopathy caused by screw threads.Pedicle screw fixation is a useful procedure for posterior reconstruction of the cervical spine. This procedure does not require the lamina for stabilization, and should be especially valuable for simultaneous posterior decompression and fusion. The risk to neurovascular structures, however, cannot be completely eliminated.