Comparative Analysis of Various Techniques of Craniovertebral Junction Fusion Surgery and Their Various Complications

The craniovertebral junction (CVJ) is a complex anatomical and biomechanical region that demands precise surgical techniques to address instability and compressive pathologies. Multiple fixation methods have been developed, including anterior odontoid screw fixation, C1–C2 transarticular and lateral mass screw constructs, pedicle screw systems, and occipitocervical fusion. Despite advances in instrumentation, these procedures remain associated with significant morbidity, most notably vertebral artery injury, dural tears, implant failure, neurological deficits, and wound complications. This review analyzes published literature on the complications of various CVJ fusion techniques and compares them with findings from our retrospective series of 154 patients operated over a 10-year period. The series highlighted vertebral artery injuries (1.9%), dural tears (1.2%), pressure sores (2.5%), implant failures (0.6%), as well as postoperative neurological deterioration, infections, and mortality. Nevertheless, most patients demonstrated significant postoperative improvement in pain (VAS) and neurological function (Nurick’s grade). Our analysis underscores that complication rates vary depending on surgical approach, anatomical variations, surgeon expertise, and preoperative planning. Advanced imaging, meticulous preoperative risk assessment, and the use of 3D-printed CVJ models for trajectory planning can substantially reduce vascular and neurological complications. In conclusion, careful selection of fixation technique, knowledge of anatomical variations, and surgeon experience are pivotal in achieving optimal outcomes while minimizing perioperative risks in CVJ surgery.