[Hot topic of cranial vertebral surgery: the surgical plan of type A basilar invagination]

Regarding the treatment of type A basilar invagination, there is a debate between the combination of anterior and posterior surgery and posterior fixation. The author's personal opinion on the hot topic of cranial vertebral surgery: the surgical plan of type A basilar invagination is expressed in this article. Overall, the combined anterior-posterior approach is applicable in almost all cases of type A basilar invagination, regardless of how severe atlantoaxial dislocation, and simple posterior surgery is only in cases where atlantoaxial dislocation is not very severe. The anterior-posterior combined surgery has two incisions, and the risk of postoperative infection is higher than for posterior surgery alone. If the patient has no spinal cord symptoms, only posterior surgery is acceptable, even if no anatomical reduction can be achieved. If there is a more severe spinal cord dysfunction, or a large syringomyelia, anterior atlantoaxial release is necessary to ensure achieving anatomical reduction and restoring the normal morphology of the cervical spinal cord.