Abstract
Unilateral anterior retropharyngeal approach was used in a case of basilar invagination with atlanto-axial instability. This approach provided easy access to both atlanto-axial joints. Wedge-shaped titanium cages were used to distract the joints and reduce the basilar invagination. Titanium plates with screws were used to fix the lateral mass of atlas with the body of axis, bilaterally. The anterior atlanto-axial joint distraction procedure has not been described in literature before seems to be an easy option in selected cases of craniovertebral anomalies and needs to be investigated by more surgeons.