A case of severe basilar invagination and AAD, corrected using the technique of DCER-distraction, compression, extension, reduction (with spacer + universal reducer).

The author has described his own technique of DCER (distraction, compression, extension, and reduction) to reduce and realign the deformity and relieve spinal compression (indicated in congenital anomalies with occipitalized C1 arch). In addition, he developed special C1-2 spacers and a universal reducer. Here, a 30-year-old male with severe BI (20 mm, above the clivus) with AAD underwent the technique of spacer placement (distraction) followed by cable reduction (leading to compression and extension at the occiput-C1-C2 region). Another short example is presented where an 8-year-old boy (severe BI, AAD with posterior fossa dermoid) underwent additional correction-C2 forward translation and excision of the dermoid. The video can be found here: https://youtu.be/XIMpkYjxgRk.