title: Transfacet screw placement for posterior fixation of C-7.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurological Surgery, Indiana University College of Medicine, Indianapolis, Indiana 46202-5124, USA. emhorn@iupui.edu
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horn
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
authors.forename: Neil R
authors.initials: NR
authors.lastname: Crawford
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Bambakidis
authors.forename: Volker K H
authors.initials: VK
authors.lastname: Sonntag