{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T09:05:18Z","timestamp":1789290318133,"version":"build-2803163510"},"reference-count":0,"publisher":"Indian Orthopaedic Research Group","issue":"8","content-domain":{"domain":["jocr.co.in"],"crossmark-restriction":true},"short-container-title":["Jocr"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>Introduction: Basilar invagination (BI) with atlantoaxial instability is a complex craniovertebral junction (CVJ) disorder that causes progressive cervicomedullary compression and disabling myelopathy. Although reduction-based techniques such as distraction\u2013compression\u2013extension\u2013reduction (DCER) have expanded surgical options, conventional occipitocervical fusion remains an important stabilization strategy in selected patients with rigid deformity, advanced neurological compromise, or infective CVJ pathology.\n\nMaterials and Methods: This retrospective case series included three patients with BI and atlantoaxial instability, including one with infective C1\u2013C2 spondylodiscitis, who underwent posterior occipitocervical fusion with foramen magnum decompression between 2024 and 2025. Clinical outcomes were assessed using the Nurick grade, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI). Radiographic evaluation included the atlantodental interval (ADI), clivo-axial angle (CXA), Chamberlain\u2019s line, and McRae\u2019s line. Perioperative complications and neurological outcomes were recorded. All patients completed 12 months of follow-up.\n\nResults: All patients presented with advanced myelopathy (Nurick Grade III\u2013V) and marked craniovertebral instability (ADI, 6.2\u20139.0 mm; CXA, 125\u2013132\u00b0). Posterior occipitocervical fusion with foramen magnum decompression was successfully completed in all patients without intraoperative neurological deterioration, implant-related complications, or revision surgery. Neurological status remained stable or improved throughout follow-up. The patient with infective spondylodiscitis demonstrated improvement in VAS (8\u20133) and ODI (64\u201338%), whereas all patients achieved radiographic construct stability at final follow-up.\n\nConclusion: Occipitocervical fusion with foramen magnum decompression provided satisfactory neurological stabilization, radiographic stability, and functional improvement in this small series of patients with complex BI and atlantoaxial instability. It remains a valuable stabilization strategy for selected patients when reduction-based techniques are not feasible.\n\nKeywords: Basilar invagination, atlantoaxial instability, Occipitocervical fusion, craniovertebral junction, cervical myelopathy, spondylodiscitis, clivo-axial angle, Nurick grade.<\/jats:p>","DOI":"10.13107\/jocr.2026.v16.i08.7956","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:55:45Z","timestamp":1786629345000},"page":"575-581","update-policy":"https:\/\/doi.org\/10.13107\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Back to Basics at the Craniovertebral Junction: Occipito-Cervical Fusion for Basilar Invagination with Atlantoaxial Instability"],"prefix":"10.13107","volume":"16","author":[{"given":"Sunil","family":"Khemka","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Shree Narayana Hospital, Raipur, Chhattisgarh, India,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manindra","family":"Bhushan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Spine Surgery, Shree Narayana Hospital, Raipur, Chhattisgarh, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandesh Subhash","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Spine Surgery, Shree Narayana Hospital, Raipur, Chhattisgarh, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pritam","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shree Narayana Hospital, Raipur, Chhattisgarh, India,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambrish","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shree Narayana Hospital, Raipur, Chhattisgarh, India,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram","family":"Khemka","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shree Narayana Hospital, Raipur, Chhattisgarh, India,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5271","published-online":{"date-parts":[[2026]]},"container-title":["Journal of Orthopaedic Case Reports"],"original-title":[],"deposited":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T08:45:25Z","timestamp":1789289125000},"score":1,"resource":{"primary":{"URL":"https:\/\/jocr.co.in\/wp\/2026\/08\/back-to-basics-at-the-craniovertebral-junction-occipito-cervical-fusion-for-basilar-invagination-with-atlantoaxial-instability\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026]]},"published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.13107\/jocr.2026.v16.i08.7956","relation":{},"ISSN":["2321-3817"],"issn-type":[{"value":"2321-3817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"Research Article","name":"content_type","label":"Content Type"},{"value":"Yes","name":"crosschecked","label":"CrossChecked"},{"value":"Yes","name":"peer_reviewed","label":"Peer Reviewed"},{"value":"10.13107\/jocr.2026.v16.i08.7956","name":"published","label":"Published"},{"value":"Creative Commons Attribution","name":"license","label":"License","explanation":{"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},"group":{"name":"rights","label":"Rights"}}]}}