Objective To investigate the feasibility and safety of the treatment for upper cervical spine fractures with posterior pedicle screw fixation through the paraspinal approach via Quadrant channel. Methods From January 2015 to December 2016, 15 cases of upper cervical spine fractures were treatment with posterior pedicle screw fixation through the paraspinal approach via Quadrant channel. There were 11 male and 4 female, ranging from 19 to 46 years of age (mean 33.4 years) at surgery. The time from injury to surgery varied from 1 d to 5 d (mean 2.1 d). 6 cases had fractures of the atlas, 7 cases were the axis and 2 cases were the atlas and axis. According to Frankel grading system, 5 cases were Grade D and 10 Grade E. Their Frankel grade, Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) score were compared between preoperation and final follow-up. Results No intraoperative complications occurred such as spinal cord injury and vertebral artery rupture. Median operating time was 89 min (range 75-120 min) and median blood loss was 96 mL (range 40-180 mL). Fracture reduction and pedicle screws placement were excellent, that evaluated by postoperative X-ray and three-dimensional computerized tomography (CT), and the operative incisions were healing well. Average follow-up time was 17.4 months (range 12-36 months). Bony union was obtained in all after an average time of 12.9 weeks. At the final follow-up, all the patients were assessed as Frankel Grade E. Their mean JOA and VAS scores were significantly improved from 8.3 ± 1.4 and 7.2 ± 1.6 preoperatively to 13.2 ± 1.5 and 1.2 ± 0.9, respectively (P?0.05). One patient had the right side of occipital numbness but this symptom disappeared at 1 week after surgery. There were no instances of instrumentation failure and no patient had persistent postoperative cervicodorsal pain. Conclusion Posterior pedicle screw fixation for upper cervical spine fractures through the paraspinal approach via Quadrant channel has the obvious advantages of less invasive and blood loss, and decreases the risk of postoperative cervicodorsal pain.