The craniovertebral junction is unique and the most complex of the axial skeleton in multiple aspects; embryology, anatomy, pathology and kinematics. A surgical physiological approach to management of its abnormalities was instituted at the University of Iowa Hospitals & Clinics (UIHC) in 1977 and has been the accepted treatment algorithm worldwide. A global referral led to a prospective database of more than 7,000 adult and pediatric patients; 3,600 of whom were treated at UIHC. 975 children (less than 18 years of age) were surgically managed. The commonest symptoms and signs were neck pain and headache, neurological deficit due to brain stem and spinal cord compression, vascular issues secondary to vertebral artery compression and the Chiari malformation. 

Craniovertebral junction, Atlantoaxial dislocation, Basilar invagination, Fiberoptic intubation, Intraoperative reduction of cervicomedullary compression, Klippel-Feil syndrome, Anesthesia