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Objective: To report the surgical technique and preliminary clinical results for the treatment of basilar invagination (BI) with atlantoaxial dislocation (AAD) by posterior-only intraoperative reduction and fixation.Methods: Between January 2009 and June 2013, 21 patients (male 12, female 9) who had BI with AAD underwent surgery at our institution.The mean age, cause of disease, pre-operative JOA score and cervicomedullary angle was 37.9±10.7 years, 4.3±3.9 years, 11.2±1.8 and 122.1°±13.6°respectively.The JOA scores of spinal cord function were calculated pre-and post-operatively to evaluate the resolution of neural fiction.The Chamberlian line (CL)、 Wackenheim line (WL)、 McRae line (ML) and atlantodens interval (ADI) were measured to assess the degree of dislocation.