Dr. Centeno reviews which CCI patients are more likely to need surgery. The presentation discusses the indications for elective surgical fusion in patients with craniocervical instability (CCI), excluding cases with fractures or severe instability. Most CCI patients do not require surgery, but those with high atlantodental intervals (ADI), significantly reduced clivo-axial angles (CXA), static brainstem compression, severe Chiari malformations (greater than type I), congenital cervical abnormalities, inability to tolerate ePICL procedures, or failure of legitimate ePICL treatments with persistent severe symptoms may be candidates. For those needing surgery, it is advised to select surgeons who routinely perform upper cervical fusions, as only about five surgeons worldwide manage approximately 80% of such elective cases.

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