Vertebral artery mobilization for C1-2 reduction and fixation

Craniocervical instability due to chronic atlantoaxial dissociation presents the challenge of providing adequate decompression, reduction, and fixation to promote long-term stability while avoiding iatrogenic vertebral artery dissection or entrapment. The authors present one patient with chronic atlantoaxial dissociation and basilar invagination treated via Goel's technique and with bilateral vertebral artery mobilization. There was substantial decompression and reduction postoperatively and the patient was discharged with a stable examination. Vertebral artery mobilization at the C1-2 junction can be safely performed via a standard midline suboccipital incision and dissection without vertebral artery injury. The video can be found here: https://youtu.be/VS1Mt1dBLO4.