{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T13:11:06Z","timestamp":1788873066201,"version":"build-2803163510"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Intraoperative 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Percutaneous 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1871976","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:35:23Z","timestamp":1785216923000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Uni-portal non-coaxial spinal endoscopic surgery on percutaneous hollow screw fixation for atypical hangman's fracture: a novel minimally invasive technique case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Kai","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Minzu Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]},{"name":"Department of Spine and Osteopathy, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Sun","sequence":"additional","affiliation":[{"name":"Orthopedics and Traumatology Department, Luliang County Traditional Chinese Medicine Hospital","place":["Qujing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxian","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Spine and Osteopathy, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haijun","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Spine and Osteopathy, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingxiu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Spine and Osteopathy, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Spine and Osteopathy, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongcai","family":"Teng","sequence":"additional","affiliation":[{"name":"Department of Spine and Osteopathy, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shangyu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Spine and Osteopathy, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danting","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Spine and Osteopathy, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianming","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Spine and Osteopathy, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingxin","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Spine and Osteopathy, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyi","family":"Quan","sequence":"additional","affiliation":[{"name":"Department of Spine and Osteopathy, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengde","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"En","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of 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