Endoscopic-Assisted Atlantoaxial Fusion: A Minimally Invasive Approach to Upper Cervical Instability

The craniovertebral junction, where the skull meets the upper cervical spine, is one of the most demanding regions in spine surgery. The spinal cord and vertebral arteries lie close together in a very small space. Recently, the spine team at The First Affiliated Hospital of Guangxi Medical University performed an endoscopic-assisted posterior atlantoaxial lateral mass joint fusion with screw-rod fixation. The team was led by Prof. Xinli Zhan, with Associate Prof. Chong Liu as the operating surgeon.

Clinical Background

The patient had occipitocervical pain, limb numbness and an unsteady gait. These are typical symptoms of atlantoaxial instability. The aim of treatment is to restore alignment and achieve stable fusion, while protecting the spinal cord and vertebral arteries.

Conventional open posterior fusion requires extensive soft-tissue dissection. Endoscopic surgery reduces this trauma, but it has its own difficulties: a narrow working channel, a two-dimensional view and limited instrument movement. It therefore demands precise anatomical judgment and fine surgical control.

Preoperative Planning

The team carried out a multimodal imaging assessment before surgery, including X-ray, CT, CT angiography (CTA) and MRI. This allowed them to:

• Assess atlantoaxial alignment and the bony anatomy.
• Map the vertebral artery course and any anatomical variation.
• Plan the screw trajectories, endoscopic channel and extent of joint preparation.
• Prepare contingency plans for bleeding and limited visualization.

The Role of the Endoscope

Under high-definition, magnified endoscopic visualization, the surgeon carried out the deep joint work through a minimally invasive channel. This included cartilage removal from the C1-C2 lateral mass joint, preparation of the fusion bed and placement of bone graft. Rod reduction and fixation followed. Postoperative imaging showed satisfactory reduction, appropriate screw position and accurate graft placement.

Published Research

The technique has been described in two peer-reviewed publications from the team:

• Xue J, et al. Innovative One-Hole Split Endoscopy for Posterior Atlantoaxial Lateral Mass Joint Fusion: Technical Details and Preliminary Clinical Application. Int J Spine Surg. 2026;20(2):178-185. doi:10.14444/8851
• Zhu J, et al. Endoscopic-Assisted Posterior Atlantoaxial Fusion: Technical Innovation and Clinical Experience. Orthopaedic Surgery. 2026;18(8):1768-1782. doi:10.1111/os.70358

About the Hospital

The First Affiliated Hospital of Guangxi Medical University is a major teaching hospital in Nanning, China. Its Department of Spine Surgery and Osteopathy continues to develop minimally invasive techniques for complex cervical conditions.

This article is for general information only and is not medical advice. Suitability for surgery depends on each patient's individual condition and must be assessed by a qualified spine specialist.