Abstract
BACKGROUND: Atlantoaxial pseudoarticulation is a rare condition characterized by atypical joint formation at C1-2, potentially causing severe neck pain and progressive cervical myelopathy due to spinal cord compression. Traditional treatments often involve decompression with or without fusion and can lead to significant tissue disruption and extended recovery time. Here, the authors describe a novel, minimally invasive full endoscopic technique for resecting atlantoaxial pseudoarticulation, achieving successful spinal decompression. OBSERVATIONS: A 44-year-old female patient presented with 6 months of progressive cervical myelopathy, including gait instability, right-sided weakness, and numbness. Imaging confirmed a C1-2 pseudoarticulation causing severe spinal cord compression. A paraspinal endoscopic approach was used, avoiding the need for instrumented fusion. Postoperatively, the patient's condition rapidly improved, with complete symptom resolution at 6 months and only mild intermittent hand numbness at 18 months. Imaging confirmed stable, effective decompression without complications. LESSONS: This case represents the first documented application of a full endoscopic approach for atlantoaxial pseudoarticulation, achieving effective decompression while preserving spinal integrity and reducing recovery time. This technique offers a promising, minimally invasive alternative for complex cervical pathologies, supporting a shift toward less invasive, tissue-sparing spinal surgery. https://thejns.org/doi/10.3171/CASE24766.