{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:53:08Z","timestamp":1785775988135,"version":"3.56.0"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["NSFC82360422"],"award-info":[{"award-number":["NSFC82360422"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Atlantoaxial instability or dislocation requires reliable posterior stabilization and fusion to prevent neurological deterioration. Although conventional Goel\u2013Harms posterior fixation provides effective biomechanical stability, it usually requires extensive posterior cervical muscle dissection and may be associated with substantial blood loss, postoperative axial pain, and soft\u2010tissue morbidity. Despite the advantages of minimally invasive endoscopic techniques in spinal surgery, clinical evidence regarding their application in the management of AAI\/D remains limited. In this study, we report a clinical series of endoscopic\u2010assisted atlantoaxial lateral mass fusion, provide a detailed description of the key surgical steps, and evaluate its technical feasibility, safety, and early clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixteen patients diagnosed with AAI\/D underwent endoscopic\u2010assisted posterior atlantoaxial fusion. The procedure utilized a uniportal endoscopic system through a 2.5\u20133.0\u2009cm incision, enabling direct visualization of the C1\u2013C2 lateral mass joint, precise screw placement, and intra\u2010articular bone grafting under continuous irrigation. Radiographic parameters, neurological function (JOA), pain (VAS), and neck disability (NDI) scores were assessed pre\u2010 and postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All surgeries were successfully completed without intraoperative neurovascular injury or hardware malposition. The mean operative time was 103.06\u2009\u00b1\u20099.55\u2009min, and the mean blood loss was 40.06\u2009\u00b1\u20099.28\u2009mL. The atlantodental interval (ADI) decreased from 5.14\u2009\u00b1\u20091.51\u2009mm preoperatively to 3.37\u2009\u00b1\u20090.52\u2009mm postoperatively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and C1\u2013C2 joint height increased from 2.98\u2009\u00b1\u20090.27\u2009mm to 4.37\u2009\u00b1\u20090.49\u2009mm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). At 3\u2009months, bone fusion was achieved in 93.8% of patients. Clinical outcomes improved compared with preoperative values, including JOA score (8.44\u2009\u00b1\u20090.89 to 13.31\u2009\u00b1\u20091.20), VAS score (8.00\u2009\u00b1\u20090.73 to 2.25\u2009\u00b1\u20090.45), and NDI score (31.88\u2009\u00b1\u20091.93 to 12.88\u2009\u00b1\u20091.26).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study introduces a novel minimally invasive technique for managing atlantoaxial instability using uniportal endoscopic\u2010assisted posterior fusion. The combination of direct endoscopic visualization, accurate screw\u2013rod fixation, and controlled intra\u2010articular bone grafting offers reliable joint stabilization with reduced tissue disruption. Clinical outcomes suggest this approach may facilitate rapid recovery and improved perioperative safety, offering a valuable addition to current surgical strategies for AAI\/D.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70358","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T08:04:07Z","timestamp":1781078647000},"page":"1768-1782","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic\u2010Assisted Posterior Atlantoaxial Fusion: Technical Innovation and Clinical Experience"],"prefix":"10.1111","volume":"18","author":[{"given":"Jichong","family":"Zhu","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengqian","family":"Huang","sequence":"additional","affiliation":[{"name":"The Affiliated Hospital of Youjiang Medical University for Nationalities  Baise China"},{"name":"Key Laboratory of Molecular Pathology in Tumors of Guangxi Higher Education Institutions  Baise China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Xue","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiarui","family":"Chen","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufan","family":"Xu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dequan","family":"Liu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6936-481X","authenticated-orcid":false,"given":"Xinli","family":"Zhan","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2479-3001","authenticated-orcid":false,"given":"Chong","family":"Liu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2040496.248"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics12071615"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3171\/2015.1.FOCUS14807"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2012.03.012"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.07.008"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14134657"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-024-08318-2"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2012.01.054"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2449404.702"},{"issue":"3","key":"e_1_2_12_11_1","first-page":"467","article-title":"History of Endoscopic Spine Surgery: Where Did It All Begin? 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