Realignment of Basilar Invagination by C1–C2 Joint Distraction: A Modified Approach to a Paradigm Shift

  • Francesco Cacciola
  • Bronek Boszczyk
  • Paolo Perrini
  • Pasquale Gallina
  • Nicola Di Lorenzo
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)


Background: Distraction of the C1–C2 joint and maintenance thereof by introduction of spacers into the articular cavity can successfully and durably reduce basilar invagination (BI). Thus, with the adjunct of instrumented fusion and decompression, BI-induced myelopathy can be efficiently treated with a one-stage posterior approach. This intervention is technically challenging, and in this paper we describe a procedural variation to facilitate the approach.

Methods and Results: Through a description of a case of BI, the main anatomopathological alteration underlying and perpetrating the condition of BI is elucidated. A technique of realignment of BI is then described in which this alteration is specifically targeted and neutralized. The result is a single-stage posterior-only approach with decompression, C1–C2 distraction and introduction of poly(methyl methacrylate) (PMMA) into the joint cavity. Instrumented occipitocervical fusion completes the procedure.

Conclusion: C1–C2 joint distraction is a technically demanding procedure. By providing a modification of the original technique and a detailed description of the crucial steps necessary to successfully and safely carry it out, we hope to make this excellent procedure more approachable.


Basilar invagination Surgical treatment Joint distraction Posterior fusion 


Competing Interests

The authors declare that they have no competing interests.

Compliance with Ethical Standards

No financial support was received for this work.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Francesco Cacciola
    • 1
  • Bronek Boszczyk
    • 2
  • Paolo Perrini
    • 1
  • Pasquale Gallina
    • 3
    • 4
  • Nicola Di Lorenzo
    • 3
    • 4
  1. 1.Department of NeurosurgeryAzienda Ospedaliero Universitaria Senese (AOUS)SienaItaly
  2. 2.Centre of Spinal Surgery and Studies, Queens Medical CentreNottinghamUK
  3. 3.Department of NeurosurgeryAzienda Ospedaliero Universitaria Pisana (AOUP)PisaItaly
  4. 4.Department of NeurosurgeryUniversity of FlorenceFlorenceItaly

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