Uni-portal non-coaxial spinal endoscopic surgery on percutaneous hollow screw fixation for atypical hangman's fracture: a novel minimally invasive technique case report.

PURPOSE: This study reports a case of type B1 atypical Hangman's fracture and introduces a novel minimally invasive hollow pedicle screw insertion technique for the treatment of unstable Hangman's fracture. METHODS: A 65-year-old male was admitted after an electric bicycle fall, presenting with occipital and cervical pain and numbness. Upon admission, his pain level was assessed as 7 on the Visual Analogue Scale (VAS), with a Neck Disability Index (NDI) score of 19. Cervical CT examination revealed multiple lucent lines in the axis, accompanied by diastasis, displacement, and fractures of the lateral transverse processes, leading to a diagnosis of type B1 atypical Hangman's fracture (AHF). The patient underwent percutaneous hollow pedicle screw fixation assisted by uni-portal non-coaxial spinal endoscopic surgery (UNSES). RESULTS: Intraoperative blood loss was minimal, and postoperative CT confirmed satisfactory reduction of the axis fracture. At the 1-month follow-up, the patient's incision had healed well, symptoms had markedly improved (VAS score of 1, NDI score of 7). At the 10th-month follow-up, cervical CT showed significant fracture healing compared to previous examinations. By the 1-year follow-up, the patient's symptoms further improved (VAS score 0, NDI score 3). CONCLUSION: Percutaneous hollow pedicle screw fixation for AHF under the assistance of UNSES is feasible, offering advantages such as minimal invasiveness, a broad surgical field, and rapid postoperative recovery.