Laminar screw fixation in the subaxial cervical spine: A report on three cases

Figure 4 Surgical procedures. A: Create a small cortical window at the junction of the C3 spinous process and the lamina on the right; B: Using a hand drill, carefully drill along the length of the contralateral (left lamina), with the drill visually aligned among the angle of the exposed contralateral laminar surface; C: Insert a 3.5 mm diameter polyaxial screw along the same trajectory in the left C3 lamina. Palpate the ventral lamina with a Penfield dissector to verify that no cortical breakthrough into the spinal canal has occurred; D: Using the same technique as above, insert a 3.5 mm diameter polyaxial screw into the left C4 lamina. Place appropriate rods into the screw heads and attach to C3 and C4 screws.