Posterior intra-articular distraction with cage placement to treat congenital atlantoaxial dislocation associated with basilar invagination Congenital atlantoaxial dislocation (AAD) associated with basilar invagination (BI) is a complex congenital malalignment at the craniovertebral junction. The olisthesis, atlantoaxial facet joint arthropathy, and the contraction of the anterior soft tissue make the treatment challenging. Our video demonstrates the surgical technique for posterior intra-articular distraction with cage placement to treat congenital atlantoaxial dislocation associated with basilar invagination.