Spine Surgery pp 423-428 | Cite as

Basilar Invagination

  • Anja TschuggEmail author
  • Sebastian Hartmann
  • Claudius Thomé


The occipitocervical junction is a complex transitional zone between the cranium and the upper spine. It composes two major joints: the atlantooccipital and atlantoaxial joint. This region allows half of cervical flexion-extension motion in the segment C0/C1 and about half of cervical rotation at C1/C2. Bilateral banding, distraction and axial loading are other important features of this region.


Basilar invagination Craniocervical fusion Chiari malformation Craniocervical junction Craniocervical instability 

References and Level of Evidence (EBM)

  1. 1.
    White AA, Panjabi MM. The clinical biomechanics of the occipitoatlantoaxial complex. Orthop Clin North Am. 1978;9:867–78. EBM VGoogle Scholar
  2. 2.
    Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights Imaging. 2017;8:29–47. EBM VCrossRefGoogle Scholar
  3. 3.
    Pan J, Huang D, Hao D, et al. Occipitocervical fusion: fix to C2 or C3? Clin Neurol Neurosurg. 2014;127:134–9. EBM IVCrossRefGoogle Scholar
  4. 4.
    Winegar CD, Lawrence JP, Friel BC, et al. A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine. 2010;13:5–16. EBM IIPubMedGoogle Scholar
  5. 5.
    Chaudhry NS, Ozpinar A, Bi WL, Chavakula V, Chi JH, Dunn IF. Basilar Invagination: Case Report and Literature Review. World Neurosurg. 2015;83:1180.e7–11. EBM VCrossRefGoogle Scholar
  6. 6.
    Smith JS, Shaffrey CI, Abel MF, Menezes AH. Basilar Invagination. Neurosurgery. 2010;66:A39–47. EBM VCrossRefGoogle Scholar
  7. 7.
    Goel A. Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine. 2004;1:281–6. EBM IVPubMedGoogle Scholar
  8. 8.
    Wholey MH, Bruwer AJ, Baker HL. The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology. 1958;71:350–6.CrossRefGoogle Scholar
  9. 9.
    Yoon SD, Lee CH, Lee J, Choi JY, Min WK. Occipitocervical inclination: new radiographic parameter of neutral occipitocervical position. Eur Spine J. 2017;26:2297–302. EBM IVCrossRefGoogle Scholar
  10. 10.
    Yamazaki M, Okawa A, Furuya T, et al. Anomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed tomographic angiography: analysis of 100 consecutive surgical cases and review of the literature. Spine (Phila Pa 1976). 2012;37:E1389–97. EBM IIICrossRefGoogle Scholar
  11. 11.
    Gluf WM, Brockmeyer DL. Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients. J Neurosurg Spine. 2005;2:164–9. EBM IVGoogle Scholar
  12. 12.
    Guzman JZ, Feldman ZM, McAnany S, Hecht AC, Qureshi SA, Cho SK. Osteoporosis in cervical spine surgery. Spine (Phila Pa 1976). 2016;41:662–8. EBM IVCrossRefGoogle Scholar
  13. 13.
    Stone MA, Jakoi AM, Iorio JA, et al. Bisphosphonate’s and intermittent parathyroid Hormone’s effect on human spinal fusion: a systematic review of the literature. Asian Spine J. 2017;11:484–93. EBM IIICrossRefGoogle Scholar
  14. 14.
    Wolfla CE, Salerno SA, Yoganandan N, Pintar FA. Comparison of contemporary occipitocervical instrumentation techniques with and without C1 lateral mass screws. Neurosurgery. 2007;61:87–93. discussion 93. EBM VCrossRefGoogle Scholar
  15. 15.
    Yüksel KZ, Crawford NR, Melton MS, Dickman CA. Augmentation of occipitocervical contoured rod fixation with C1-C2 transarticular screws. Spine J. 2007;7:180–7. EBM VCrossRefGoogle Scholar
  16. 16.
    Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M. Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine (Phila Pa 1976). 1999;24:1425–34. EBM IVCrossRefGoogle Scholar
  17. 17.
    Lall R, Patel NJ, Resnick DK. A review of complications associated with Craniocervical fusion surgery. Neurosurgery. 2010;67:1396–403. EBM IIICrossRefGoogle Scholar
  18. 18.
    Deutsch H, Haid RW, Rodts GE, Mummaneni PV. Occipitocervical fixation: long-term results. Spine (Phila Pa 1976). 2005;30:530–5. EBM IVCrossRefGoogle Scholar
  19. 19.
    Clarke MJ, Toussaint LG, Kumar R, Daniels DJ, Fogelson JL, Krauss WE. Occipitocervical fusion in elderly patients. World Neurosurg. 2012;78:318–25. EBM IVCrossRefGoogle Scholar
  20. 20.
    Shkarubo AN, Kuleshov AA, Chernov IV, Vetrile MS. Transoral decompression and anterior stabilization of atlantoaxial joint in patients with basilar impression and Chiari Malformation Type I: a technical report of 2 clinical cases. World Neurosurg. 2017;102:181–90. EBM VCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Anja Tschugg
    • 1
    Email author
  • Sebastian Hartmann
    • 1
  • Claudius Thomé
    • 1
  1. 1.Department of NeurosurgeryMedical University InnsbruckInnsbruckAustria

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