Frontiers in Surgery · Published 2026-07-28 · DOI 10.3389/fsurg.2026.1871976
Kai Luo, Fei Sun, Wenxian Huang, Haijun Tang, Mingxiu Yang, Wei Dai, Hongcai Teng, Shangyu Liu, Danting Xiao, Jianming Hu, Jingxin Deng, Haiyi Quan, Shengde Liang, En Song, Yun Liu
PurposeThis 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.MethodsA 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).ResultsIntraoperative 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).ConclusionPercutaneous 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.
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Luo, K., Sun, F., Huang, W., et al. (2026). Uni-portal non-coaxial spinal endoscopic surgery on percutaneous hollow screw fixation for atypical hangman's fracture: a novel minimally invasive technique case report. Frontiers in Surgery. https://doi.org/10.3389/fsurg.2026.1871976