Basilar Invagination, Basilar Impression, and Cranial Settling

Spine Center

Appointment New Patient Appointment or 214-645-8300

The expert team of doctors at UT Southwestern Medical Center specializes in treating basilar invagination, basilar impression, and cranial settling. At the Spine Center, we offer thorough diagnostic evaluations and both nonsurgical and surgical treatment options.

Expert Treatment for Complex Spine Conditions

Although their names are often 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 rheumatoid arthritis and Paget’s disease.


Symptoms of these spinal conditions vary in severity and can include:

  • Head and neck pain
  • Weakness
  • Dizziness
  • Confusion
  • Trouble swallowing
  • Numbness


If we suspect that a patient has 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 can include:


After diagnosis, we make sure a patient see the right experts to treat his or her specific symptoms. Treatments can include:

  • Anti-inflammation drugs
  • Biofeedback
  • Cortisone injections
  • Physical therapy
  • Surgery

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.

Clinical Trials

As an academic medical center, we’re at the forefront of spine research. Our patients have the opportunity to participate in clinical trials aimed at improving the treatment of spinal conditions such as basilar invagination, basilar impression, and cranial settling. Talk with our doctors to see if a clinical trial is available.

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