Q: What is the treatment for atlanto-axial dislocation with basilar invagination associated with neck pain? I am not getting sound sleep. I feel giddy sometimes. Can I drive a car? Is there any cure bother than surgery, or by means of physiotherapy? Is wearing a neck collar advisable?

A:Basilar invagination is a term denoting an abnormality of the base of the skull just above the atlas vertebra. This part of the base of the skull is deformed and compresses the hind brain and adjacent spinal cord. The atlas and axis, respectively, are the first and second vertebrae located immediately below the skull. The atlas is anchored to the axis but can rotate around a central pillar, thus permitting us to turn our heads from side to side. Abnormalities of development or disease can permit abnormal forward movement (more common) or backward movement of the atlas on the axis. This can lead to compression of the uppermost part of the spinal cord and cause serious problems for the patient. This is the reason for fixing the atlas on the axis and taking pressure of the spinal cord at these levels as soon as such instability and abnormal movements are detected. There is no non-surgical treatment. A collar can help reduce abnormal movements of the atlas but cannot eliminate them.