Fig. 5.

Five safety steps for avoiding neurovascular complications in the initial surgical learning period are as follows: First, the screw entry points should be determined based on a preoperative computed tomography scan. Second, small-sized and curved pedicle probes can be used to ensure a proper medial angle for screw insertion. Third, a pedicle breach can be detected using a ball-tip probe. Fourth, the cervical pedicle screw should be changed to a lateral mass screw when a breach is detected. The final step is the ability to interpret intraoperative anterior-posterior radiographs after screw insertion.