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Study Design. Retrospective evaluation of complications in 180 consecutive patients with cervical disorders who had been treated by using pedicle screw fixation systems.To determine the risks associated with pedicle screw fixation in the cervical spine and to emphasize the importance of preoperative planning and surgical techniques in reducing the risks of this procedure.Generally, pedicle screw fixation in the cervical spine has been considered too risky for the neurovascular structures. There have been several reports describing the complications of lateral mass screw–plate fixation. However, no studies have examined in detail the complications associated with cervical pedicle screw fixation.One hundred eighty patients who underwent cervical reconstructive surgery using cervical pedicle screw fixation were reviewed to clarify the complications associated with the pedicle screw fixation procedure. Cervical disorders were spinal injuries in 70 patients and nontraumatic lesions in 110 patients. Seven hundred twelve screws were inserted into the cervical pedicles, and the locations of 669 screws were radiologically evaluated.Injury of the vertebral artery occurred in one patient. The bleeding was stopped by bone wax, and no neurologic complication developed after surgery. On computed tomographic (CT) scan, 45 screws (6.7%) were found to penetrate the pedicle, and 2 of 45 screws caused radiculopathy. Besides these three neurovascular complications directly attributed to screw insertion, radiculopathy caused by iatrogenic foraminal stenosis from excessive reduction of the translational deformity was observed in one patient.The incidence of the clinically significant complications caused by pedicle screw insertion was low. Complications associated with cervical pedicle screw fixation can be minimized by sufficient preoperative imaging studies of the pedicles and strict control of screw insertion. Pedicle screw fixation is a useful procedure for reconstruction of the cervical spine in various kinds of disorders and can be performed safely.