Surgical Outcomes of Craniovertebral Junction Anomalies: A Decade of Precision and Perseverance at a Tertiary Center

Background: Craniovertebral junction (CVJ) anomalies comprise congenital and acquired disorders affecting the occiput–C1–C2 complex, often resulting in instability, basilar invagination (BI), and neural compression. Surgical management aims to restore alignment, achieve stabilization, and prevent neurological deterioration. Objective: This study evaluates the clinical and radiological outcomes of surgical management of CVJ anomalies at a tertiary neurosurgical centre. Material and Methods: A retrospective analysis was performed on 154 patients who underwent surgery for CVJ anomalies between January 2014 and December 2023. Clinical assessment included Visual Analogue Scale (VAS), Nurick grade, and Oswestry Disability Index (ODI). Radiological parameters – atlantodental interval (ADI), clivus-canal angle, and craniometric lines – were compared pre- and postoperatively. Surgical techniques included C1 lateral mass–C2 pedicle screw fixation (Goel–Harms), occipitocervical fusion (OCF), and individualized alternatives based on anatomy and reducibility. Results: The cohort included 96 males and 58 females (mean age-27.6 years). Atlantoaxial dislocation (77%) and BI (53%) were the most common. Goel–Harms fixation was used in 81% and OCF in 13%. Mean VAS improved from 5.68 ± 1.74 to 1.53 ± 1.06, Nurick grade from 3.54 ± 1.12 to 2.13 ± 0.94, and ODI from 47.5 ± 11.9 to 21.15 ± 8.7 ( P < 0.001). ADI reduced from 6.43 ± 1.14 mm to 1.89 ± 1.31 mm, and clivus-canal angle increased from 130.2° ± 8.0° to 145.6° ± 5.4° ( P < 0.001). Bony fusion was achieved in 93% of patients. Complications (21%) were mainly minor wound issues. Conclusion: Posterior fixation, particularly Goel–Harms constructs, provides reliable stabilization, high fusion rates, and significant clinical improvement in CVJ anomalies, with individualized surgical planning ensuring optimal outcomes and minimal complications.