Abstract

Background: Posterior atlantoaxial arthrodesis remains a cornerstone in the surgical management of atlantoaxial instability or dislocation (AA I/D). However, its application is frequently complicated by substantial intraoperative blood loss and postoperative axial pain. The increasing use of endoscopic spinal surgery provides a promising avenue for addressing these issues.
Methods: This study introduces an innovative, minimally invasive technique for atlantoaxial fusion, one-hole split endoscopy for posterior atlantoaxial lateral mass joint fusion. We designed a detailed surgical protocol and perioperative management strategy, followed by a preliminary clinical application to evaluate the technical advantages and clinical feasibility.
Results: A 12-year-old boy, diagnosed with AAI, os odontoideum, and myelopathy, underwent the novel endoscopic fusion procedure in conjunction with atlantoaxial screw fixation. Postoperative images confirmed successful reduction of the atlantoaxial lateral mass joint and satisfactory graft fusion. At the six-month follow-up, computed tomography reconstruction revealed continuous bony bridging across the lateral mass joint space, indicating an initial osseous fusion.
Conclusion: To our knowledge, this is the first clinical application of posterior atlantoaxial lateral mass joint fusion using one-hole split endoscopic system, demonstrating its clinical feasibility and technical advantages, and offering a novel, efficient, precise, and safe option for procedures involving the craniovertebral junction.

Keywords

Atlantoaxial instability or dislocation, one-hole split endoscopy, atlantoaxial fusion, endoscopic cervical surgery