Transoral Approach with Reverse Pedicle Screw Technique for the Treatment of Chronic Levine-Edwards Type III Hangman’s Fracture: A Case Report, Surgical Technique, and Literature Review

Background This report navigated transoral anterior pedicle screw technique achieved secure fixation for unstable hangman's fracture. It circumvented posterior approach risks and anterior contamination concerns. This offers a paradigm for complex cases where posterior fixation is unsuitable. Case presentation We report a 58-year-old male presenting with a C2 vertebral body fracture, right C2 pedicle fracture, and concurrent C2/3 disc injury, which manifested as a chronic fracture (4 weeks post-trauma). Despite multiple courses of conservative treatment and use of a cervicothoracic orthosis, fracture displacement progressed. No significant neurological deficits were noted. The fracture was reduced and stabilized via a transoral approach using a bilateral reverse pedicle screw technique with cortical bone compression screws. A 2-cm incision was made, with a total surgical duration of 1 hours and intraoperative blood loss of 20 mL; no neurovascular injuries occurred. Immediate intraoperative fracture reduction and fixation were achieved, and no postoperative infections were observed. Postoperatively, the patient wore a cervical collar, initiated neck rehabilitation at 48 hours, and resumed daily activities within 1 week. The Visual Analog Scale (VAS) score decreased from 4 (preoperatively) to 0 (1 week postoperatively), the Japanese Orthopaedic Association (JOA) score improved from 11 to 16, and the Neck Disability Index (NDI) decreased from 28% to 6%. Following-up CT imaging demonstrated satisfactory fusion. Conclusion The minimally invasive transoral approach combined with reverse pedicle screw fixation is an effective surgical option for treating Levine-Edwards Type III chronic Hangman’s fracture. This study provides a reference for optimizing surgical strategies in the management of upper cervical trauma.