CMOS pixel sensor cells with spacer transfer gates and methods of manufacture are provided herein. The method includes forming a middle gate structure on a gate dielectric. The method further includes forming insulation sidewalls on the middle gate structure. The method further includes forming spacer transfer gates on the gate dielectric on opposing sides of the middle gate, adjacent to the insulation sidewalls which isolate the middle gate structure from the spacer transfer gates. The method further includes forming a photo-diode region in electrical contact with one of the spacer transfer gates and a floating diffusion in electrical contact with another of the spacer transfer gates.