Objective: To investigate the feasibility and safety of the posterior surgical treatment of unstable Hangman fractures under general anesthesia with two types of endotracheal intubation. Methods: Retrospective analysis was performed on 37 patients admitted to our hospital from January 2014 to June 2019. All patients underwent posterior cervical pedicle screw fixation and fusion, among which 24 patients received general anesthesia via orotracheal intubation (OTI) and 13 received general anesthesia via nasotracheal intubation (NTI). The success rate of intubation, complications, and postoperative clinical and imaging follow-up data of the two groups were recorded. Results: All the 37 patients received the operation successfully. Compared to NTI group, the exposure time and intubation time of OTI group were significantly reduced (P < 0.05), but there was no significant difference in the success rate of one-time intubation and the incidence of complications between the two groups (P > 0.05). The NDI scores of OTI group and NTI group were improved from (24.18±2.66) and (23.25±3.14) before operation to (5.22±1.06) at the last follow-up. JOA score increased from 7.28±2.36 and 6.86±2.54 before operation to 19.22±2.32 and 19.02±1.92 at the last follow-up. The NDI and JOA scores of the two groups were significantly different before and after surgery, but there was no significant difference between the two groups. At the last follow-up, the cervical lordosis Angle and C2-3 slip rate of the two groups were significantly improved compared with those before surgery, but there was no significant difference between the two groups. Conclusions: The use of posterior short-segment cervical pedicle screw fixation and fusion in the treatment of unstable Hangman fractures can achieve satisfactory clinical efficacy, and both anesthesia intubation methods of NTI and OTI are safe and feasible.