Anterior retropharyngeal cage distraction with atlantoaxial plate-screw fixation for basilar invagination with atlantoaxial dislocation.

The unilateral submandibular anterior retropharyngeal approach in properly selected patients offers the possibility to expose both atlantoaxial joints adequately, abrade the endplates, and graft the joint spaces. The supine position in extension permits the use of wedge-shaped cages, which reduce the invagination and correct the dislocation. Adequate bone stock is available to rigidly fix the joints using an anterior plate-screw construct without any risk to the vertebral arteries. The approach preserves the posterior tension band and the C2 root. The technique is quick, simple, and safe, and results in solid fusion of the joints over time. The video can be found here: https://youtu.be/tT6j3Czy6tc.