OBJECTIVE : To analyze the safety and efficacy of skipping instrumentation at the C7 vertebra during posterior cervicothoracic fusions. METHODS : This is a retrospective chart review of 53 patients who underwent multilevel posterior cervical fusion between 2010 and 2015. Of 53 patients, 7 patients were instrumented at C7, serving as the control group, whereas the remaining 46 patients were not. Evaluation of efficacy was based on intraoperative complications, operative time, estimated blood loss, significant long-term complications, and radiographic evidence of fusion. RESULTS : Skipping the C7 level resulted in a significant reduction in estimated blood loss (321 ± 214 mL in the C7 bridge group vs. 531 ± 365 mL in the control group) and an insignificant, but decreased, reduction in operative time (155 ± 70 minutes in the C7 bridge group vs. 194 ± 66 minutes in the control group). Two intraoperative complications were noted in the C7 group, and 1 intraoperative complication was noted in the control group. In addition, patients skipped at C7 maintained sagittal balance with fusion rates similar to control patients at follow-up. No significant long-term complications were found in both groups. CONCLUSIONS : Skipping C7 in a multilevel posterior cervicothoracic fusion demonstrates significantly reduced estimated blood loss and faster operative times compared with the control group. In addition, postoperative assessment yielded similar rates of fusion in both groups. Serious negative outcomes of skipping C7 were not found in this retrospective study. Our study results illustrate the clinical benefits of skipping instrumentation at C7 to minimize surgical risk in patients undergoing posterior cervical fusion across the cervicothoracic junction.