Endoscopic Posterior Cervical Fusion for the Treatment of Atlantoaxial Pathologies

BACKGROUND AND OBJECTIVES: Surgery for the upper cervical spine (atlantoaxial region) is a significant challenge because of its complex anatomy and proximity to vital neurovascular structures. Traditional posterior approaches require extensive muscle dissection, leading to considerable tissue trauma. Although endoscopic techniques have revolutionized minimally invasive spine surgery, their application for simultaneous decompression, fusion, and internal fixation in the atlantoaxial region has not been previously documented. This study aims to preliminarily investigate the technical feasibility, safety, and early clinical outcomes of a newly developed endoscopic posterior cervical fusion procedure. METHODS: We performed a retrospective analysis of patients with upper cervical pathologies who underwent this novel technique. Using a single-portal unilateral or bilateral approach based on the arthroscopic-assisted uniportal spinal surgery/uniportal non-coaxial spinal endoscopic surgery technique, the entire procedure-including neural decompression, preparation of the atlantoaxial joint surfaces, bone grafting, and the placement of a screw-rod construct (using C1/C2 pedicle screws, C1 posterior arch screws, or C2 laminar screws)-was completed under continuous endoscopic visualization. RESULTS: Ten patients underwent successful surgery without conversion to an open procedure. A total of 40 screws were placed. Postoperative imaging revealed 2 left C1 pedicle screws positioned slightly medially; all other screws were correctly placed. One case of postoperative cerebrospinal fluid leak was managed conservatively. No vertebral artery injuries, neurological deterioration, or infections occurred. All patients showed significant clinical improvement in pain and function scores, and follow-up imaging confirmed solid bony fusion in every case. CONCLUSION: Endoscopic posterior cervical fusion is technically feasible. This technique effectively merges the advantages of endoscopic minimally invasive surgery with the requirement for rigid spinal fixation, showing promising early results with satisfactory fusion rates and clinical outcomes.