Transfacet screw fixation of the subaxial cervical spine--how I do it?

Transfacet screw fixation is a biomechanically effective way of fusing the subaxial cervical spine. The technique used by this author is described.

With the patient in prone position, a conventional posterior exposure of the cervical spine is done. The entry point used by this author is 2 mm above the middle of the lateral mass without any lateral angulation. Under fluoroscopic guidance the facet is drilled until all the four cortical surfaces are purchased. Then the depth is measured to assess the length of the screw required. This is followed by tapping and screw insertion both of which are done under fluoroscopic control. All screws are placed prior to laminectomy to decompress the cervical cord.

This is a simple, inexpensive and biomechanically effective way of stabilizing the subaxial cervical spine.