Basilar Invagination, Basilar Impression, and Cranial Settling

Although their names often are used interchangeably, basilar invagination, basilar impression, and cranial settling are different but similar conditions. All three of these complex conditions involve the area where the skull meets the top of the spine, and all can cause compression of the spinal cord.

Basilar impression occurs when parts of the cervical (neck) vertebrae enter the hole in the skull base (foramen magnum). Basilar invagination is the same problem, except that it’s caused by softening in the bones at the skull base. Cranial settling occurs when the bone at the top of the neck on which the skull rotates (dens) extends into the foramen magnum.

The conditions can be present at birth (congenital) or develop later in life (acquired) due to conditions that include arthritis and Paget’s disease.

The expert team of doctors at UT Southwestern’s Spine Center specializes in all available evidence-based treatments for these conditions – both nonsurgical and surgical.

When surgery is required, our skilled surgeons can perform minimally invasive procedures – robotically in many cases – reducing the recovery time and the risk of surgery.

Our multidisciplinary approach allows you access to neurosurgeons, orthopaedists, and other specialists with one call. We strive to coordinate, facilitate, and expedite patient care, saving our patients time.

Our goal is to partner with our patients in their care, get them back to health as soon as possible, and help them achieve the best outcomes.


If we suspect that you have basilar invagination, basilar impression, or cranial settling, we’ll conduct a physical examination and order additional testing. Tests, procedures, and imaging studies used to diagnose these conditions include:

  • Computed tomography (CT scan)
  • Magnetic resonance imaging (MRI)
  • Myelogram, an imaging procedure for the spine


After diagnosis, we’ll make sure you see the right experts to treat your specific symptoms.

In severe or advanced cases, our team of specialists are able treat cranial settling by surgically removing the dens and stabilizing the vertebrae at the top of the spine.

We perform a robot-assisted transoral odontoidectomy to treat basilar invagination.

Clinical Trials

UT Southwestern conducts clinical trials aimed at improving the treatment of spinal conditions such as basilar invagination, basilar impression, and cranial settling. Talk with your doctor to see if a clinical trial is right for you.

Meet Our Experts

UT Southwestern Spine Center specialists who treat basilar invagination, basilar impression, and cranial settling include:

Learn more about the Spine Center team.

Request an Appointment

To schedule an appointment with a specialist in basilar invagination, basilar impression, and cranial settling at UT Southwestern’s facilities in Dallas or to learn more about our services, request an appointment or call 214-645-8300.