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Updated: Jun 11, 2026
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Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion
Published on: June 16, 2023
Endoscopic-Assisted Posterior Atlantoaxial Fusion: Technical Innovation and Clinical Experience.
Jichong Zhu1, Chengqian Huang2,3, Jiang Xue1
1The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Orthopaedic Surgery
|June 10, 2026
Summary
This study introduces endoscopic-assisted posterior fusion for atlantoaxial instability (AAI/D), demonstrating safe and effective joint stabilization with reduced tissue disruption. The technique shows promising results for rapid recovery and improved perioperative outcomes in AAI/D patients.
Area of Science:
- Minimally Invasive Spinal Surgery
- Cervical Spine Fusion Techniques
- Endoscopic Surgical Procedures
Background:
- Atlantoaxial instability (AAI/D) necessitates posterior stabilization and fusion to prevent neurological damage.
- Conventional Goel-Harms fixation can lead to extensive muscle dissection, significant blood loss, and postoperative pain.
- Limited clinical evidence exists for minimally invasive endoscopic techniques in managing AAI/D.
Purpose of the Study:
- To report a clinical series of endoscopic-assisted atlantoaxial lateral mass fusion.
- To detail the surgical steps of this novel minimally invasive technique.
- To evaluate the technical feasibility, safety, and early clinical outcomes of endoscopic-assisted AAI/D management.
Main Methods:
- Sixteen patients with AAI/D underwent uniportal endoscopic-assisted posterior atlantoaxial fusion via a small incision (2.5-3.0 cm).
- The procedure allowed direct visualization of the C1-C2 lateral mass joint for precise screw placement and intra-articular bone grafting.
- Pre- and postoperative assessments included radiographic parameters, Japanese Orthopaedic Association (JOA) scores, Visual Analog Scale (VAS) pain scores, and Neck Disability Index (NDI) scores.
Main Results:
- All surgeries were completed successfully with no intraoperative complications; mean operative time was 103.06 minutes and mean blood loss was 40.06 mL.
- Significant improvements were observed in radiographic parameters, including a decrease in the atlantodental interval (ADI) and an increase in C1-C2 joint height (p < 0.001).
- At 3 months, 93.8% of patients achieved bone fusion, with significant improvements in JOA, VAS, and NDI scores compared to preoperative values.
Conclusions:
- Uniportal endoscopic-assisted posterior fusion is a novel, minimally invasive technique for AAI/D management.
- This approach provides reliable joint stabilization with reduced tissue disruption through direct visualization and precise instrumentation.
- The technique demonstrates potential for rapid recovery and enhanced perioperative safety, representing a valuable alternative surgical strategy for AAI/D.
