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

作者：Kai Luo, Fei Sun, Wenxian Huang, Haijun Tang, Mingxiu Yang, Wei Dai, Hongcai Teng, Shangyu Liu, Danting Xiao, Jianming Hu, Jianan Deng, Haiyi Quan, Shengde Liang, En Song, Yun Liu · 发表于：Frontiers in Surgery · 年份：2026 · DOI：10.3389/fsurg.2026.1871976 · 研究领域：Spinal Fractures and Fixation Techniques、Cervical and Thoracic Myelopathy、Scoliosis diagnosis and treatment

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 re...