An Approach to Managing Disorders Affecting the Craniovertebral Junction

The craniovertebral junction (CVJ), or the “first junction,” can be affected by a variety of pathological states. Some of these conditions could represent a gray area in that they can be treated by general neurosurgeons or such specialists as skull base or spinal surgeons. However, some conditions are best managed with a multidisciplinary approach. The importance of in-depth knowledge of the anatomy and biomechanics of this junction cannot be overemphasized. Identifying what represents clinical stability or instability is key to successful diagnosis and, hence, treatment. In this report, the second in a 3-article series, we describe our approach to managing CVJ pathologies in a case-based fashion to illustrate key concepts.