Transfacet screw placement for posterior fixation of C-7

Technical note

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Lateral mass screws are traditionally used to fixate the subaxial cervical spine, while pedicle screws are used in the thoracic spine. Lateral mass fixation at C-7 is challenging due to thin facets, and placing pedicle screws is difficult due to the narrow pedicles. The authors describe their clinical experience with a novel technique for transfacet screw placement for fixation at C-7.


A retrospective chart review was undertaken in all patients who underwent transfacet screw placement at C-7. The technique of screw insertion was the same for each patient. Polyaxial screws between 8- and 10-mm-long were used in each case and placed through the facet from a perpendicular orientation. Postoperative radiography and clinical follow-up were analyzed for aberrant screw placement or construct failure.


Ten patients underwent C-7 transfacet screw placement between June 2006 and March 2007. In all but 1 patient screws were placed bilaterally, and the construct lengths ranged from C-3 to T-5. One patient with a unilateral screw had a prior facet fracture that precluded bilateral screw placement. There were no intraoperative complications or screw failures in these patients. After an average of 6 months of follow-up there were no hardware failures, and all patients showed excellent alignment.


The authors present the first clinical demonstration of a novel technique of posterior transfacet screw placement at C-7. These results provide evidence that this technique is safe to perform and adds stability to cervicothoracic fixation.

Abbreviations used in this paper:PS = pedicle screw.

Article Information

Address correspondence to: Eric M. Horn, M.D., Ph.D., Department of Neurological Surgery, Indiana University College of Medicine, 545 Barnhill Drive, 139 Emerson Hall, Indianapolis, Indiana 46202-5124. email:

© AANS, except where prohibited by US copyright law.



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    Schematic demonstrating the entry points (black dots) on the dorsal surface of the facets for the C-7 transfacet screw. The crosshairs represent the midpoint of the facet surface.

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    Schematic demonstrating the trajectory and orientation of the C-7 transfacet screw in the sagittal (upper) and coronal (lower) planes.

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    Case 1. Left: Sagittal T1-weighted MR image with contrast demonstrating extensive cervicothoracic osteomyelitis. Right: Reformatted sagittal CT scan demonstrating cervicothoracic osteolysis and kyphosis.

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    Case 1. Lateral radiograph (left) and sagittal, reformatted CT scan (right) demonstrating the posterior fixation construct. Note the orientation of the C-7 transfacet screw in relation to the traditional facet screws at the levels above.

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    Case 1. Sagittal, reformatted CT scan obtained 9 months postfixation demonstrating excellent alignment and fusion.

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    Case 5. Sagittal, reformatted CT scan (left) and anteroposterior radiograph (right) demonstrating position of the C-7 screws in the sagittal and coronal planes after cervicothoracic fixation.

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    Case 7. Left: Sagittal T2 weighted MR image demonstrating severe cervical spondylosis and anterolisthesis at C7–T1. Right: Sagittal, reformatted CT scan obtained 2 months postfixation demonstrating excellent alignment and screw position.



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